Abstract

Background/Objectives: Dietary adherence and physical activity are pivotal yet understudied behavioral components of self-management of type 2 diabetes mellitus (T2DM) in the Middle East and North Africa region. This study aimed to quantify dietary adherence and physical activity levels, examine their association, and identify sociodemographic and clinical factors independently associated with these outcomes among adults with T2DM in southwest Saudi Arabia—a region chronically underrepresented in the literature. Methods: A descriptive cross-sectional study (n = 257; December 2023–March 2024) was conducted at a specialist diabetes center. The Perceived Dietary Adherence Questionnaire (PDAQ; 0–56 after removal of the fat-avoidance item with near-zero item-total correlation) and General Practice Physical Activity Questionnaire (GPPAQ) were administered alongside body mass index (BMI) and glycated hemoglobin (HbA1c) extracted from medical records. Bonferroni-corrected non-parametric bivariate tests, multiple linear regression with variance inflation factor diagnostics, and binary logistic regression were applied. Results: Mean 8-item PDAQ was 20.44 ± 10.04/56 (36.5%); carbohydrate spacing was the critical deficit (16.4%). GPPAQ distribution: 10.1% inactive, 28.0% moderately inactive, 49.0% moderately active, and 12.8% active, with sensitivity analysis ranging 28.0–47.5% in the two lowest categories. PDAQ–GPPAQ correlation was weak (Spearman r = 0.18; 95% CI: 0.06–0.29; r2 = 0.032). BMI alone accounted for 81.0% of PDAQ score variance (cross-sectional; direction of association not established; full model Adj. R2 = 0.826; LOO-CV R2 = 0.820, indicating model stability). Employment type showed the strongest cross-sectional association with GPPAQ-derived inactivity classification (housewife OR = 5.77; retired/seeking OR = 4.98 vs. employed), largely driven by the occupational component of the composite score. Conclusions: Dietary adherence was substantially below the maximum achievable score; BMI was the factor most strongly associated with PDAQ scores in cross-sectional analysis, though the direction of this relationship cannot be established. Physical activity levels were substantially associated with occupational patterns; housewives and retired/other participants faced approximately five-fold greater odds of being classified as inactive or moderately inactive compared with employed individuals. The weak PDAQ–GPPAQ correlation (r2 = 0.032) suggests these behaviors are not strongly co-determined and points to the potential value of distinct, hypothesis-generating intervention approaches for dietary quality and leisure-time physical activity in T2DM populations.

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