Non-communicable diseases (NCDs) are the leading cause of global mortality, particularly prevalent in low to middle-income countries (LMICs). Hypertension and type 2 diabetes mellitus often coexist, contributing to long-term complications and mortality. Lifestyle interventions, including dietary modifications, are vital in preventing these complications. This study aimed to assess nutrition knowledge and dietary practices among patients with diabetes and hypertension at Kitale County Referral Hospital. This descriptive cross-sectional study focused on patients with type 2 diabetes and hypertension at Kitale County Referral Hospital. Data were collected from 283 respondents out of a target population of 973 using structured questionnaires. The Social Cognitive Theory guided the study, emphasizing the interaction of individual, behavioral, and environmental factors influencing self-care activities. Most participants demonstrated an understanding of dietary management for their conditions. Cultural influences posed challenges, yet participants reported familial and social support. Willingness to change dietary habits was evident, but barriers such as food availability and cost were noted. Despite adequate nutrition education, adherence to balanced diets remained problematic. The study highlights the importance of sustained patient education and counselling, incorporating experiential learning such as hospital kitchen use to promote locally available foods. Strategies to address food insecurity, particularly among the elderly, are recommended to enhance dietary adherence and overall health outcomes. Efforts to improve dietary practices among patients with type 2 diabetes and hypertension should prioritise culturally sensitive education, accessibility to recommended foods, and addressing socioeconomic barriers. These recommendations could significantly enhance self-care behaviours and health outcomes in similar healthcare settings.