Background <p>E-health literacy is closely linked to a wide range of health outcomes, encompassing the control of diseases, self-efficacy, and the quality of life concerning health, as well as the attitudes and behaviors exhibited by patients. Therefore, we conducted this study to investigate e-health literacy and examine the relationship between e-health literacy and self-care behaviors in Iranian middle-aged type 2 diabetes.</p> Methods <p>This cross-sectional study was conducted among 313 middle-aged (30–60 years) type 2 diabetics covered by the health care centers of Neyshabur City, Iran, in 2023. They were selected through a stratified random sampling method. Data was gathered using a demographic characteristics questionnaire, a Summary of Diabetes Self-care Activities, and an Electronic Health Literacy scale. Collected data were analyzed using multiple linear regression, t-test, one-way analysis of variance, and chi-square tests by SPSS software version 22, and the significance level was considered 0.05.</p> Results <p>The mean age of the respondents was 48.41 ± 7.1 years. The mean (± SD) of the diabetes Self-care activities was 49.28 (14.9), and the mean (± SD) of e-health literacy was 20.6 (7.78). Most diabetics had low e-health Literacy 192(61.5%). After adjusting for the variables of type of treatment, measuring blood sugar at home, marital status, occupation and economic status, e-health literacy (B = , 0.277, T = 4.5, <i>P</i> &lt; .05) was the statistically significant independent factor associated with diabetes self-care activities.</p> Conclusion <p>Executing educational programs focusing on promoting e-health literacy can increase diabetes self-care activities, increasing overall diabetes’s quality of life.</p>