Left ventricular hypertrophy (LVH) is a common cardiovascular abnormality in type 2 diabetes mellitus (T2DM) patients. Its predictors within Middle Eastern populations are not well documented. This study aimed to determine the prevalence and independent predictors of LVH among patients with T2DM in Saudi Arabia.A retrospective cross-sectional analysis of clinical experience was performed at a tertiary centre of diabetes in Saudi Arabia. Medical records of 625 adults with T2DM who underwent echocardiography were reviewed.Demographic characteristics, comorbidities, diabetes duration, BMI, and glycemic control were collected. LVH prevalence was determined and comparisons between patients with and without LVH were performed. Multivariable logistic regression analysis for independent predictors.There were a mean age of 65.7 ± 11.4 years, of which 53.4 percent were male. Hypertension was present in 79% of participants and 78.2% had diabetes over 15 years. Most patients had uncontrolled HbA1c (77.6%). Obesity was the most prevalent BMI category (37.1%).LVH was detected in 23.4% of patients. It showed that male gender had significant relationship with LVH (p = 0.002). There were no significant differences for LVH vs non-LVH groups in age, hypertension, duration of diabetes, BMI and glycemic control. Overall in our adjusted model, male gender continued to be the sole independent predictor of LVH (OR 1.71; 95% CI: 1.16–2.54; p = 0.007). No other independent variables predicted LVH.In this Saudi retrospective cohort, LVH was prevalent in nearly one-quarter of patients with T2DM. Male gender was the only independent predictor of LVH, underscoring the need for targeted cardiovascular screening in this subgroup. These findings contribute region-specific evidence to the understanding of diabetic cardiac complications.   Keywords Bariatric surgery, Hypoglycemia, machine learning