<p><b>OBJECTIVE: </b>We examined links among dietary patterns (DPs), insulin resistance (IR), and diabetes risk by heritage in the Hispanic Community Health Study/Study of Latinos.</p><p><b>METHODS: </b>Hispanics/Latinos of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American heritage aged 18-74 years and diabetes-free completed two 24 h dietary recalls at baseline (2008-2011) and provided 6-year follow-up data (2014-2017; n = 7774). We classified 6-year IR status [improved, unchanged (referent), worsened] using a 1-SD change in fasting insulin between visits and defined incident diabetes based on American Diabetes Association criteria. We derived heritage-specific DPs via principal factor analysis and estimated their associations with 6-year IR status (multinomial) and incident diabetes (binary) using complex survey-based logistic regression.</p><p><b>RESULTS: </b>Five overarching DPs based on high-loading foods were shared by two or more heritage groups: "Burger, Fries, & Soft Drinks"; "White Rice, Beans, & Red Meats"; "Fish & Whole Grains"; "Cheese & Sweets"; and "Stew & Corn". Comparing highest-to-lowest DP quintiles, the Dominican "Burger, Fries, & Soft Drinks" and Cuban "White Rice, Beans, & Red Meats" DPs were associated with worsened 6-year IR status (log-odds: 2.35, 95% CI: 1.02, 3.68, P = 0.037 and log-odds: 1.27, 95% CI: 0.49, 2.06, P = 0.009, respectively). The Puerto Rican "Burger, Fries, & Soft Drinks" and the Central American "White Rice, Beans, & Red Meats" DPs were associated with greater diabetes incidence (OR: 3.00, 95% CI:1.50, 5.99 and OR: 2.41, 95% CI: 1.05, 5.50, respectively).</p><p><b>CONCLUSIONS: </b>A diet characterized by higher intakes of burgers, fries, and soft drinks and another characterized by higher intakes of white rice, beans, and red meats may be adversely associated with IR and diabetes risk in some Hispanic/Latino heritage groups. Future work is needed to offer more heritage-specific dietary guidance for diabetes prevention in this population.</p>