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

Background: 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. Aim: This multi-regional study investigated the relationship between modifiable and non-modifiable risk factors and elevated AUSDRISK-defined T2DM risk among Saudi university students. Methods: 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). Results: 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. Conclusion: 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.