Interplay of Modifiable and Non-Modifiable Risk Factors for Diabetes Mellitus in Saudi Adults

<b>Background/Objectives:</b> Diabetes Mellitus (DM) remains a critical public health issue in Saudi Arabia, shaped by complex interactions among genetic, lifestyle, and sociodemographic factors. This study explores interplay of modifiable and non-modifiable determinants of DM among Saudi adults. <b>Methods:</b> An analytical cross-sectional study was conducted among 3411 adults aged 18 years and above in the Jazan region, southwest of Saudi Arabia, in May-June 2024. Data was collected via a structured, pretested questionnaire assessing sociodemographic, dietary patterns, physical activity, smoking habits, and family history of DM. Bivariate analysis and logistic regression were used to identify associations with self-reported diabetes. <b>Results:</b> Out of 3411 participants (1735 males and 1676 females), 424 (12.4%) reported DM. Diabetics were older (48 vs. 32 years), more often male, married, had lower education, had larger families, had higher BMIs, and exhibited more tobacco use (<i>p</i> < 0.05), and a family history of diabetes was strongly associated with diagnosis of DM (<i>p</i> < 0.001). Diabetics were more likely to choose low-fat meats, avoid sugary foods, and select low-fat products (<i>p</i> < 0.05). In multivariate analysis, predictors were age (OR = 1.07, 95% CI: 1.06-1.09), male sex (OR = 1.65, 95% CI: 1.26-2.16), family history (OR = 7.68, 95% CI: 5.67-10.57), traditional housing (OR = 1.82, 95% CI: 1.11-3.05), and whole grain intake (OR = 0.67, 95% CI: 0.52-0.85). <b>Conclusions:</b> DM in Saudi Arabia is driven by both inherited and behavioral risks. These findings support the urgent need for integrated, culturally tailored prevention strategies that combine early screening for individuals with higher risk. Targeted actions such as relevant lifestyle interventions can help reduce disease burden and align with Saudi Vision 2030 health priorities.