Determinants of Type 2 Diabetes Mellitus among Women Aged 46–55 Years: An Explanatory Sequential Mixed-Methods Study in West Aceh, Indonesia

Background: Type 2 diabetes mellitus (T2DM) is a major and rapidly expanding global health challenge, with a disproportionate burden in low- and middle-income countries. Indonesia is among the countries with the highest number of adults living with diabetes worldwide, with approximately 10.7 million cases reported. Women aged 46–55 years may represent a particularly vulnerable population because age-related hormonal, metabolic, and behavioral changes can increase susceptibility to dysglycemia and T2DM. In the working area of Suak Ribee Public Health Center, West Aceh Regency, 48 of 98 women aged 46–55 years were reported to have T2DM, underscoring the need to identify population-specific determinants of the disease.Objective: This study aimed to identify and quantify the factors associated with T2DM among women aged 46–55 years in the working area of Suak Ribee Public Health Center, West Aceh Regency, Indonesia.Methods: An explanatory sequential mixed-methods design was employed. The quantitative phase included women aged 46–55 years identified in the study area. Total population sampling was applied to 98 eligible women, of whom 97 provided complete data and were included in the quantitative analysis. Data were collected using a structured questionnaire and blood glucose measurement. Quantitative analyses comprised descriptive statistics, assessment of distribution using the Shapiro–Wilk test, bivariate analysis using Spearman’s rank correlation and Pearson’s chi-square or Fisher’s exact test, and multivariable analysis using binary logistic regression. A qualitative phase involving in-depth interviews was subsequently undertaken to provide contextual explanations for the dominant quantitative findings.Results: Of the 97 participants, 57 (58.8%) had blood glucose levels ≥200 mg/dL and were classified as having DM according to the study’s operational definition. Physical activity frequency was inversely correlated with blood glucose level (Spearman’s rs = −0.277; p = 0.006), as was physical activity duration (rs = −0.306; p = 0.002). A family history of DM was significantly associated with DM status (χ² = 14.484; p < 0.001). In the multivariable logistic regression model, longer physical activity duration was independently associated with lower odds of DM (OR = 0.433; 95% CI: 0.244–0.766; p = 0.004), whereas participants with a family history of DM had substantially higher odds of DM (OR = 4.779; 95% CI: 1.866–12.236; p = 0.001). The final model was statistically significant (χ² = 23.429; p < 0.001), demonstrated adequate calibration (Hosmer–Lemeshow p = 0.409), and accounted for approximately 29.5% of the variance in DM status (Nagelkerke R² = 0.295).Conclusion: Family history of DM and physical activity duration were independently associated with DM status among women aged 46–55 years in this primary healthcare population. These findings support the incorporation of family history into community-level diabetes risk stratification and the implementation of structured, context-specific physical activity promotion as complementary strategies for diabetes prevention and early detection. Further integration of the qualitative findings is warranted to elucidate the behavioral and contextual mechanisms underlying these associations.