Risk factors for type 2 diabetes mellitus among university students in Saudi Arabia: a multi-regional cross-sectional...

Currently, 28% of Saudi Arabian adults have type 2 diabetes mellitus (T2DM), projected to exceed 50% by 2030. University students remain largely unscreened despite evidence of substantial T2DM risk during this critical lifestyle transition period.

This multi-regional study investigated the relationship between modifiable and non-modifiable risk factors and elevated AUSDRISK-defined T2DM risk among Saudi university students.

A sample of 564 students from three regions of Saudi Arabia was selected using systematic random sampling across academic disciplines and levels. T2DM risk was assessed using a modified eight-item Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK; low ≤5, intermediate 6-11, high ≥12). Variables examined included sociodemographic characteristics, BMI (WHO classification), tobacco use, physical activity (IPAQ-adapted), sedentary behavior, and dietary intake (food frequency questionnaire). Binary logistic regression provided adjusted odds ratios (aOR) with 95% confidence intervals (CI) for factors independently associated with elevated AUSDRISK classification (score ≥6).

Around a third (32.4%) of participants (N = 564; 75.9% female; mean BMI 22.2 ± 4.0 kg/m²) had elevated AUSDRISK-defined T2DM risk (mean score 4.68 ± 2.70). Males had significantly higher risk than females (75.7% vs. 18.7%; p < 0.001). All overweight and obese participants (100%) were at elevated risk versus 16.0% of normal-weight peers. Bivariate analysis (n = 564) identified sex, BMI, smoking, physical activity, academic level, and dietary intake as significantly associated with elevated AUSDRISK classification (all p < 0.05). In the logistic regression restricted to non-AUSDRISK predictors (n = 558), income (aOR = 0.88, 95% CI 0.78-0.99, p = 0.033), smoking (aOR = 2.62, 95% CI 1.38-4.97, p = 0.003), sedentary behavior (aOR = 0.79, 95% CI 0.62-0.99, p = 0.041; interpreted cautiously due to potential residual confounding by sex), and academic level (aOR = 0.83, 95% CI 0.69-0.99, p = 0.039) were all independently significant. Sex, BMI, and physical activity are structural AUSDRISK components presented descriptively only.

Nearly one in three Saudi university students had elevated T2DM risk. The findings underline the urgent need for university-based, sex-specific, socioeconomically targeted interventions incorporating BMI screening, physical activity promotion, and dietary education.