This article reviewed current findings on dietary adherence in youth with type 1 diabetes mellitus (T1DM), discussed factors predicting dietary adherence, and presented directions for future research. The included studies involved youth with T1DM, presented dietary adherence data specifically, and/or described usual dietary patterns in youth. Articles that explored predictors had to focus exclusively on dietary adherence. The final sample was 23 articles. Adherence articles were organized into two categories: eating behaviors and macronutrients and dietary recommendations. Rates of adherence to eating behaviors ranged from 21% to 95%. Studies examining macronutrients and dietary recommendations revealed higher than recommended intakes of fat and saturated fat and lower than recommended intakes of fruits, vegetables, and whole grains. Six studies investigated factors predicting dietary adherence. These studies revealed associations with child behavior problems and knowledge deficits. The available literature identified many youth with T1DM struggling with adherence and not meeting dietary guidelines for their disease. Future research should examine diet in youth exclusively on intensive insulin regimens, community-based predictors of diet, and the influence of mood on dietary adherence.