Gender differences in diabetes knowledge, glycemic control, and cardiovascular risk among adults with type 2 diabetes: a cross-sectional study

Background Gender differences in diabetes knowledge, glycemic control, and cardiovascular risk remain an important public health concern. This study examined gender differences in diabetes knowledge, glycemic control, and cardiovascular risk among adults with type 2 diabetes in Saudi Arabia, with sociodemographic characteristics, lifestyle behaviors, healthcare utilization, and perceptions of recent social reforms explored as contextual factors. Methods A cross-sectional study was conducted among 336 adults with type 2 diabetes attending primary healthcare centers. Data were collected using a structured questionnaire assessing diabetes knowledge, healthcare utilization, lifestyle behaviors, and perceptions of social reforms. Clinical data included HbA1c and Framingham Risk Score (FRS) variables. Logistic regression models were developed separately for males and females. Results Women demonstrated higher diabetes knowledge than men (59.5% vs . 44.6%, p = 0.016). Among men, university education or higher was associated with substantially greater odds of appropriate knowledge compared with illiteracy (adjusted OR = 7.81, 95% CI: 1.99–30.72; p = 0.003), while among women the association remained significant but of smaller magnitude (adjusted OR = 3.93, 95% CI: 1.52–10.14; p = 0.005). Younger age was independently associated with better knowledge in both genders; participants aged 18–40 years had markedly higher odds compared with those aged >60 years (men: OR = 12.67, 95% CI: 2.67–60.05; p = 0.001; women: OR = 11.43, 95% CI: 3.79–34.51; p < 0.001). Most participants had suboptimal glycemic control, with 47.9% showing HbA1c >8% and only 19.9% achieving HbA1c <7% (p=0.889). Physical inactivity was highly prevalent, with 55.7% never engaging in exercise, and significant gender differences were observed in exercise frequency (p<0.001). Smoking was markedly higher among males (p<0.001) and contributed to higher FRS categories in men. Conclusion Although most participants reported easy access to healthcare services, gender differences in diabetes knowledge and cardiovascular risk remained evident, while glycemic control was suboptimal across both genders. These findings underscore the need for gender-sensitive diabetes education, targeted physical activity interventions, and routine cardiovascular risk assessment as integral components of diabetes care.