Diabetes mellitus (DM) is a major public-health-concern worldwide, with a rapidly increasing burden in low- and middle-income-countries such as Tunisia. Lifestyle-habits play a key role in the development of diabetes, yet population-based-data exploring these associations remain limited in the Tunisian-context. This study aimed to determine prevalence of DM, and to assess association with lifestyle-habits among a representative-sample-of-Tunisian-adults.

We conducted a population-based cross-sectional-study between November 2022 and April 2023 using a randomly distributed 10-minute-survey-questionnaire. All Tunisian-adults aged 18 years or older were eligible for the study. Data on lifestyle-habits were collected using yes/no questions. DM was defined according to the American-Diabetes-Association (ADA).

Overall, 3074 participants were included, with a mean age of 36.2 ± 13.5 years. Women represented 63.1% of the sample ( n = 1941), and 88.4% ( n = 2716) lived in urban areas. The prevalence of obesity was 12.5% ( n = 383), with no significant gender-difference (12.3% in men vs. 12.6% in women; P = 0.08). Married participants accounted for 48.9% ( n = 1504), while 48.1% ( n = 1501) lived in households with more than five-members. Unemployment was reported in 14.8% of participants ( n = 455). Active smoking was observed in 19.8% ( n = 609), daily consumption of high-fat meals in 43.4% ( n = 1335), psychological-disorders in 4.1% ( n = 125), and regular physical-activity in 23.9% ( n = 735).

The prevalence of DM was 5.4% ( n = 165). Factors significantly associated with diabetes included male sex (OR = 2.3; P < 0.001), marital status (OR = 4.4; P < 0.001), household size > 5 members (OR = 2.0; P < 0.001), unemployment (OR = 3.6; P < 0.001), smoking (OR = 5.6; P < 0.001), daily high-fat meals (OR = 2.9; P = 0.002), and psychological-disorder (OR = 3.4; P < 0.001). Regular physical-activity was associated with a lower prevalence of diabetes (3.3% vs. 6%; P = 0.004).

Diabetes is common among Tunisian adults and was associated with impaired modifiable lifestyle-factors. These findings highlight the importance of targeted prevention strategies focusing on lifestyle modification to reduce the burden of diabetes.