Risk assessment for type 2 diabetes mellitus and its association with knowledge and health beliefs among university students in three Arab countries

Type 2 diabetes mellitus (T2DM) is a growing concern in the Arab world, with university students increasingly at risk due to lifestyle factors. This study aims to assess T2DM risk, knowledge, and beliefs among university students aged ≥ 18 years in Egypt, Saudi Arabia, and Yemen. A multinational, cross-sectional study was conducted from January to April 2025 among university students aged ≥ 18 years in Egypt (lower-middle-income), Saudi Arabia (high-income), and Yemen (low-income). A multistage, stratified purposive sampling technique was used to recruit students equally from medical and non-medical faculties in at least three universities per country. Data were collected via structured, interview-based questionnaires consisting of four components: (1) socio-demographic and anthropometric data; (2) the Diabetes Knowledge Questionnaire-18 (DKQ-18); (3) the Health Belief Model Scale (HBMS); and (4) the validated Arabic version of the Australian type 2 diabetes risk assessment tool (AUSDRISK). Among 2787 university students, the mean age was 21.0 years, with the majority being female (74.9%), and enrolled in medical faculties (58.2%). Diabetes knowledge was significantly higher in Egyptians (72.6% with good knowledge) compared to Saudis (63.9%) and Yemenis (59.8%) (p < 0.001). Health beliefs followed a similar trend, while diabetes risk was significantly higher among Yemeni students (22.0% with severe risk; p < 0.001). Multiple regression analysis revealed that a higher academic year was a positive predictor of both diabetes knowledge (β = 0.155, p < 0.001) and health beliefs (β = 0.152, p < 0.001), and was negatively associated with diabetes risk (β = − 0.061, p < 0.001). Medical faculty enrollment was also positively associated with knowledge (β = − 0.411 for non-medical faculty, p < 0.001) and beliefs (β = − 0.228 for non-medical faculties, p < 0.001). Parental education and income were positively associated with knowledge and beliefs. Specifically, father’s higher education predicted greater knowledge (β = 0.047, p < 0.001), and household income was a significant predictor of both knowledge (β = 0.042, p < 0.001) and beliefs (p < 0.001). In contrast, diabetes risk was independently associated with male gender (β = 0.305, p < 0.001), older age (β = 0.123, p < 0.001), higher BMI (β = 0.284, p < 0.001), and Yemeni nationality (β = 0.080, p < 0.001). Marked differences in diabetes risk, knowledge, and beliefs were observed among students from the three countries. Interventions targeting high-risk groups are essential to improve diabetes awareness and prevention in young adults. Countries like Yemen may benefit from urgent preventive measures, while countries with moderate risk profiles may focus on health promotion and sustained education to avert future disease burdens.