Background and aims: The current study evaluates following a special diet with diet quality and comorbidities (hypertension, hypercholesterolemia, and obesity) in four racial/ethnic groups diagnosed with prediabetes or “at risk for diabetes”. Methods and results: This is a cross-sectional analysis of data from the National Health and Nutrition Examination Surveys (NHANES), 2007-2008 and 2009-2010. Sample weights were used to achieve a representative sample. Data were available for N = 2666 adults, aged ≥20 years (508 Mexican American, 294, Other Hispanic, 616 Black non-Hispanic, and 1248 White non-Hispanic) who were medically diagnosed with either prediabetes or “at risk for diabetes”. Those reporting following a special diet had greater odds of meeting saturated fat guidelines (<10% of calories) but no greater odds of adequate fiber (14 g/4184 kJ (1000 Kcal)) as compared to those not following a special diet. There was a significant association of following a diet by number of comorbidities. Regardless of race/ethnicity, reporting following a special diet was more likely for those having more comorbidities; however, number of comorbidities was not associated with diet quality. There were racial/ethnic differences in following a special diet and its association with adequate fiber intake for persons having health risks for diabetes. Black non-Hispanics who did not follow a special diet had lower odds of meeting fiber intake requirements. Conclusion: Low adherence (<15%) to fiber dietary guidelines was found across race/ethnicity for adults diagnosed at health risk for diabetes.