Background <p>Fungal infections are a significant global health burden, affecting over a billion individuals annually. Diabetes mellitus (DM) is a major risk factor, with over 7&#xa0;million diabetic patients in Saudi Arabia. This study aimed to identify common fungal pathogens and associated risk factors in DM patients at King Fahad Hospital in Medina.</p> Methods <p>A retrospective-observational study analyzed electronic records of DM patients with positive fungal cultures from 2016 to 2021. Data included demographics, medical history, fungal isolates, resistance patterns, and biochemical parameters.</p> Results <p>A 54.5 fold increase in fungal infections was observed over five years, likely reflects the synergistic impact of the COVID-19 pandemic and enhanced diagnostic surveillance alongside the physiological vulnerability of a growing diabetic population struggling with poor glycemic and renal management. Male DM patients had a higher incidence of candidiasis. <i>Candida parapsilosis</i> was the most common species, followed by <i>C. albicans</i>. High fasting glucose, elevated HbA1c, and increased creatinine levels were significantly associated with higher infection rates. Bloodstream infections were most prevalent, followed by cutaneous and respiratory infections. Resistance was observed primarily in hospitalized patients, with <i>C. krusei</i>, <i>C. dubliniensis</i>, and <i>C. parapsilosis</i> demonstrating significant resistance.</p> Conclusions <p>This study highlights the significant burden of fungal infections in DM patients in Saudi Arabia. <i>Candida</i> species were the predominant isolates. Elevated glycemic control and renal function were major risk factors. The lack of a national fungal infection surveillance program hinders accurate assessment of the true burden of this disease. These findings emphasize the need for improved diagnostic strategies, targeted antifungal therapies, and enhanced surveillance programs to effectively manage fungal infections in DM patients.</p>