Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The global prevalence of diabetes is increasing at an alarming rate, leading to a concomitant rise in complications associated with the disease. This study aimed to explore the associations of DM complications with sociodemographic factors, comorbidities, diabetes status, and lifestyle habits among participants in Riyadh, Saudi Arabia. The findings highlight the complexity of factors contributing to DM complications, emphasizing the necessity for targeted interventions.
Sociodemographic factors
Sociodemographic characteristics play a significant role in the development of diabetes complications. In this study, age emerged as a crucial determinant, with older participants (aged 36 years and above) showing a higher complication rate (47%) than younger individuals (20%). This finding is consistent with international research indicating that age is a significant risk factor for diabetes-related complications. For example, a study conducted by Xu et al.25 in China reported that older age was positively correlated with increased rates of diabetic nephropathy and retinopathy, emphasizing the cumulative effects of chronic hyperglycemia and the natural aging process.
Furthermore, educational attainment influenced complication rates, with individuals with a bachelor’s degree or higher exhibiting lower rates (29%) than those with lower education levels (46%). This observation aligns with findings from a study by Sharif et al.26 in Pakistan, which revealed that higher health literacy positively impacts diabetes self-management, leading to better health outcomes and reduced complication risks. Conversely, those with lower educational levels often lack access to reliable health information, resulting in poor management of their diabetes.
In terms of marital status, married individuals had a higher complication rate, potentially due to shared lifestyle habits or increased stressors associated with family responsibilities. This finding is supported by a study conducted in Jordan by Alzubaidi et al.27, which highlighted that married individuals often face challenges in managing diabetes due to familial obligations, leading to poorer health outcomes. Conversely, unmarried individuals exhibited better health management practices, suggesting the importance of social support in managing chronic conditions.
Diabetes-related status
The association between diabetes-related status and complications was significant in this study. The participants with a family history of diabetes presented a complication rate of 67%, corroborating the findings of Alharbi et al.28 in Saudi Arabia, which emphasized the genetic predisposition to diabetes and its complications. Additionally, the duration of diabetes emerged as a critical factor; individuals diagnosed for more than five years experienced a complication rate of 76%. This finding aligns with international research29, which indicated that a longer diabetes duration is correlated with an increased risk for microvascular and macrovascular complications.
Moreover, the presence of diabetes symptoms such as polyuria and polydipsia, which are significantly associated with higher complication rates, reflects the findings of Sulaiman et al.30. Adherence to diabetes medications is crucial in managing blood glucose levels and preventing the development of diabetes-related complications. Consistent use of prescribed medications helps maintain better glycemic control, which in turn reduces the risk of complications such as cardiovascular disease, neuropathy, and kidney damage. Studies have shown that individuals who adhere to their diabetes medication regimen are less likely to experience these complications compared to those who are non-adherent. In our study, while the proportion of participants with poor medication adherence was low, they were found to have a 1.534 times higher risk of developing complications, highlighting the critical role of adherence in long-term diabetes management. This study highlighted the importance of early symptom recognition and management, as poorly controlled symptoms can lead to serious complications, emphasizing the need for ongoing monitoring and patient education.
Comorbidities
The relationship between comorbidities and diabetes complications is well documented in the literature. In this study, 72% of the participants with hypertension experienced a staggering complication rate. This finding is consistent with research by Khan et al.31, who reported that the prevalence of hypertension among diabetic patients significantly increased the risk of cardiovascular complications. Comorbid conditions, such as heart disease and hyperlipidemia, were also strongly associated with increased complication rates. A study by Aunapuu et al.32 in Estonia indicated that diabetes is often accompanied by cardiovascular diseases, significantly increasing the risk of mortality among patients.
Obesity emerged as a significant factor, with a complication rate of 76% among obese participants, corroborating findings from Elhassan et al.33, who identified obesity as a critical factor influencing diabetes-related complications. The interaction between obesity and diabetes exacerbates the risk of developing complications, reinforcing the need for lifestyle interventions that target weight management.
The impact of comorbidities is further illustrated by research from Faria et al.34, which demonstrated that patients with diabetes and multiple comorbid conditions face a relatively high incidence of complications, underscoring the need for comprehensive management approaches that address both diabetes and its associated comorbidities.
Lifestyle and diet
Lifestyle and dietary choices significantly impact the risk of developing diabetes complications. In this study, the consumption of processed foods and white bread was associated with a higher complication rate. This finding resonates with the research conducted by Al-Najjar et al.35, which emphasized that diets high in refined carbohydrates and sugars are associated with poor glycemic control and an increased risk of complications. The importance of promoting healthy dietary practices cannot be overstated, as evidenced by a study in Canada36, which highlighted the benefits of a Mediterranean diet in reducing diabetes complications.
Interestingly, regular exercise was associated with a lower complication rate (p = 0.001; RR = 0.799), supporting the literature on the benefits of physical activity in improving glycemic control. A systematic review by Colberg et al.37 underscored the role of physical activity in reducing the risk of cardiovascular disease and diabetes complications. This highlights the importance of incorporating regular exercise into diabetes management plans.
Moreover, milk consumption emerged as a protective factor, which aligns with findings from Kamel et al.38, suggesting that dairy products may play a role in metabolic health among diabetic patients. These findings emphasize the need for dietary recommendations that incorporate nutrient-dense foods to promote better health outcomes.
Impact on diabetes-related complications
Several studies across the Middle East and globally echo the findings of this research. In a comprehensive review by Malek et al.39, the associations between lifestyle factors and diabetes complications were explored, revealing that sedentary lifestyles and poor dietary habits significantly increase the risk of complications. Similarly, a meta-analysis by Chen et al.40 indicated that lifestyle interventions, including diet and exercise, effectively reduce the risk of complications among individuals with diabetes.
Moreover, regional studies, such as that by Qureshi et al.41 in the Gulf Cooperation Council (GCC) region, highlighted the role of sociodemographic factors in influencing diabetes management. Their findings indicated that cultural beliefs and socioeconomic status significantly affect diabetes self-management and the development of complications.
In Turkey, a study by Öztürk et al.42 emphasized the critical role of health literacy in diabetes management, supporting the findings of this study regarding the impact of educational attainment on complication rates. Their research highlighted the necessity for targeted educational programs to improve health outcomes among diabetic patients.
Internationally, the relationship between comorbidities and diabetes complications has been extensively documented. A systematic review by Sarwar et al.43 reported that comorbid conditions such as cardiovascular disease, kidney disease, and hypertension significantly increase the risk of complications in diabetic patients. This finding reinforces the findings of this study regarding the need for integrated management strategies addressing both diabetes and its comorbidities.
In summary, the findings of this study contribute to the growing body of literature on diabetes complications, underscoring the multifaceted nature of the disease. The interplay among sociodemographic factors, diabetes status, comorbidities, and lifestyle choices presents a complex landscape that requires comprehensive and individualized approaches to diabetes management. The need for health education, early intervention, and lifestyle modifications is paramount in mitigating the risks associated with diabetes complications.
Cultural beliefs and practices in Saudi Arabia
Cultural beliefs and practices in Saudi Arabia significantly influence the management of diabetes and the associated risk of complications. Traditional dietary practices, such as the consumption of high-calorie, carbohydrate-rich foods (e.g., kabsa and mutabbaq), can negatively affect blood glucose control. Additionally, the cultural practice of fasting during Ramadan can present challenges for individuals with diabetes, as changes in eating patterns may lead to unsafe fluctuations in blood sugar levels if not carefully managed44.
Physical activity levels are generally low in Saudi Arabia due to the hot climate and a sedentary lifestyle, especially in urban areas like Riyadh. Cultural norms, particularly for women, can further limit participation in exercise, impacting diabetes management45. Although walking is culturally acceptable, environmental and social barriers reduce opportunities for regular physical activity, which is essential for controlling diabetes.
Furthermore, while there is respect for medical professionals in Saudi Arabia, many individuals rely on traditional medicine, including herbal remedies and cupping, which may not always be effective in managing diabetes46. This reliance on alternative treatments can delay appropriate medical care and increase the risk of complications. Family dynamics also play a key role in diabetes management, with family support being both a positive influence and a potential barrier, especially when family gatherings encourage overeating.
Limitations
Despite the significant findings of this study, several limitations must be acknowledged to contextualize the results appropriately. The cross-sectional nature of the research restricts the ability to draw causal inferences regarding the relationships between sociodemographic factors and the development of diabetes complications. While the data provide valuable insights into associations, they do not establish direct cause‒and‒effect pathways. Additionally, reliance on self-reported information may introduce biases, as participants may inadvertently overestimate or underestimate their health status, lifestyle habits, or adherence to treatment regimens.
The study was conducted in Riyadh, and while it provides valuable insights, the generalizability of the findings may be limited due to cultural, social, and healthcare differences across other regions of Saudi Arabia and other countries. Riyadh, as a major urban center, shares many healthcare and socioeconomic characteristics with other large cities in Saudi Arabia, which may make the results more applicable to urban populations. However, regional variations in lifestyle, healthcare access, and cultural practices may affect the outcomes, limiting the relevance of the findings to rural areas or countries with different healthcare systems. Additionally, while the sample size is sufficient for statistical analysis, it may not fully represent the diversity of the Saudi population, which further limits the generalizability of the results. The study also focused on a limited range of sociodemographic variables, potentially overlooking the influence of other critical factors such as socioeconomic status and cultural differences. To improve the generalizability of the findings, future studies should include cross-country analyses that account for a wider array of sociodemographic variables.
Another limitation is regarding glycemic control assessment. First, while nursing staff classified participants using clinical HbA1c thresholds (controlled: <7.0%; uncontrolled: ≥7.0%), these classifications lacked laboratory verification, potentially introducing misclassification bias. Second, the absence of longitudinal HbA1c or other glycemic biomarkers limited our ability to evaluate long-term metabolic control. Nevertheless, our focus on sociodemographic, lifestyle, and comorbidity factors provides clinically relevant insights, as demonstrated by Kyrou et al.47 and Sharma et al.48, who established these variables as independent predictors of diabetes outcomes. Future studies should combine both biomarker data and psychosocial determinants for a more comprehensive assessment. Finally, the presence of unmeasured confounders, such as genetic predispositions and environmental influences, could further complicate the interpretation of the results. These limitations underscore the need for further research to validate these findings and explore the underlying mechanisms influencing diabetes complications in the Saudi Arabian context.
Recommendations
Future research should adopt longitudinal designs and incorporate objective measures, such as medical records, to increase data reliability. A broader range of socioeconomic variables should be considered. The implementation of health education initiatives aimed at promoting healthy lifestyles, especially among high-risk populations, is crucial. Additionally, policymakers should foster environments conducive to healthy living, while awareness campaigns can highlight the risks of diabetes complications, encouraging early detection and better management strategies.