Original Article

PRE DIABETES IN YOUNG MEDICAL STUDENTS

Muaaz Waseem,1 Faraz Ahmed Bokhari,2 Muhammad Aakif Jalal3
Zainab Zahra,4 Mahnoor Khalid,5 Maria Aman6

Abstract ing to American Diabetes Association) and its relation

with body mass index, family history of Diabetes, die-
Introduction: A study was conducted among students tary habits, socioeconomic status and physical activity.
of a public medical college in Lahore, Pakistan to
determine proportion of pre diabetic students (Blood Methods: A cross sectional survey was conducted at
sugar levels between 100 mg/dl – 125 mg/dl, accord- Sheikh Zayed Medical Complex in February 2013 on
medical students of either gender. Data was collected
on a validated questionnaire. Fasting blood sugar lev-
Waseem M.1 els of 65 students (enrolled after taking informed con-
Fourth Year MBBS Student sent) were taken by trained co investigators through
Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, standardized glucose meter.
Lahore
Results: A total of 65 medical students (43 males and
Bokhari F.A.2 22 females) enrolled in this study. Their ages ranged
Assistant Professor, Department of Physiology, Sheikh from 18 to 23 years (mean age 20.56 ± 0.97 years). No
Khalifa Bin Zayed Al-Nahyan Medical College, Lahore student was found to be pre diabetic. Fasting blood
Jalal M.A.3 sugar level in male participant with a family history
Fourth Year MBBS Student of diabetes was significantly higher (85 ± 6.228 vs.
Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, 79.857 ± 6.602, P = 0.016).
Lahore
Conclusion: In this study, no student was found to
Zahra Z.4 be pre diabetic, though male participants with a
Fourth Year MBBS Student family history of diabetes had higher fasting blood
Sheikh Khalifa Bin Zayed Al-Nahyan Medical College,
Lahore
sugar levels. However, a larger study sample is
required so that any significant finding may be
Khalid M.5 shown, if it exists. Data on prevalence of pre-dia-
Fourth Year MBBS Student betes in youth in South Asia is scarce. The high
Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, incidence of diabetes in developing countries un-
Lahore
derlines the need to explore prevalence of pre dia-
Aman M.6 betes in the younger population.
Fourth Year MBBS Student
Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Key Words: Pre diabetes, Impaired Fasting Glucose
Lahore (IFG).

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MUAAZ WASEEM, FARAZ AHMED BOKHARI, MUHAMMAD AAKIF JALAL, et al

Introduction techniques were corrected and re-tested until an accep-

table level of variability in performance was reached.
Diabetes Mellitus (DM) is a leading cause of morbi- Prior to data collection workshops were given on
dity and mortality. Its silent nature, prolonged course pre diabetes by the co-investigators to the respective
and resulting complications affect quality of life of three classes involved. They were briefed on what pre
individuals.1 DM has an impact on public health and diabetes is, its pre valence in Pakistan, the significance
puts a burden on already meager healthcare budgets of of conducting this study and the eligibility criteria for
developing countries. Urbanization, physical inactivity the participants as for example students with pre-exis-
and changing eating pattern are major factors linked ting metabolic conditions and diseases could not parti-
with increased prevalence of DM.2 cipate.
A major concern is the emergence of Type 2 dia-
A mechanical weighing machine was used with
betes in children and young adolescents.3 It depends
0.5 kg accuracy. The height was recorded to the nea-
on the epidemiological status, non-modifiable factors
rest centimeter. The body mass index (BMI) was cal-
like age and race, and / or modifiable risk factors like
culated for each participant by taking weight in kilo-
obesity and physical inactivity. DM can be asympto-
grams and height in meter square. A standardized glu-
matic till properly diagnosed and this asymptomatic
cose meter (Glucomonitor-N Blood Glucose Meter
period is known as pre diabetes – depicting that blood
Model no: 4207) was used to measure blood sugar
glucose is raised, but not enough to be diagnosed as
levels.
diabetes. If detected early and steps taken to control
risk factors, onset of overt DM and ensuing compli- Informed consent was taken from each participant.
cations can be delayed or avoided.4 This study was The participants were then asked to fast overnight (8
conducted to elucidate the prevalence of pre-diabetes hours or more). The blood glucose reading was taken
in the young adults in a local medical school. in the morning (at around 8.00 am to 10.00 am).
The American Diabetes Association (ADA) classi-
fication was used as clinical criteria to diagnose pre
diabetes: ≤ 100 mg/dl was considered normal blood
Methods glucose level and blood glucose > 100 mg/dl and
This cross – sectional survey was conducted at Sheikh < 126 mg/dl was considered pre-diabetic (Blood sugar
Zayed Medical Complex in February 2013. The stu- level ≥ 126 mg/dl was considered diabetic).5
dents participating were from the undergraduate medi-
cal programme (MBBS) of either gender. A total of 65
students participated in this study; age range (18 – 23 Results
years). Ethical approval was granted by the Institu-
tional Review Board (IRB). A questionnaire to collect A total of 65 medical students (43 males and 22 fema-
the appropriate data required was developed and vali- les) participated in this study. Their ages ranged from
dated. It included information about fast food consum- 18 to 23 years (mean age 20.56 ± 0.97 years). No stu-
ption, levels of activity and family history of diabetes. dent was found to be pre diabetic. Detailed results are
Physical activity was determined by number of hours / shown in Table 1, 2 and 3.
day spent sedentary and exercise routine. Household Fasting blood sugar level in male participant with
income was asked to assess socioeconomic status. a family history of diabetes was significantly higher
Anthropometric measurements were taken. The (85 ± 6.228 vs. 79.857 ± 6.602, P = 0.016).

Table 1: Blood Sugar Level (BSL), Body – Mass Index (BMI) and their association with various risk factors in all parti-
cipants. N: number of participants.

BSL BMI
BSL – P value BMI – P value
N (mean BSL ± STD) N (mean BMI ± STD)
Family History of Diabetes Mellitus
No 23 (82.044 ± 6.609) 0.086 20 (22.837 ± 3.505) 0.310
Yes 42 (85.238 ± 7.726) 39 (23.885 ± 4.071)

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 PRE DIABETES IN YOUNG MEDICAL STUDENTS

BSL BMI
BSL – P value BMI – P value
N (mean BSL ± STD) N (mean BMI ± STD)
No. of hours spent sedentary
Less than 3 hours 18 (83.944 ± 7.199) 0.911 15 (22.805 ± 3.582) 0.430
More than 3 hours 46 (84.174 ± 7.715) 43 (23.696 ± 4.011)
Exercise hours per week
Less than 4 44 (85.000 ± 7.838) 0.165 41 (23.364 ± 4.025) 0.674
More than 4 19 (82.263 ± 6.674) 16 (23.843 ± 3.740)
No. of restaurant visits
Less than twice per week 44 (84.456 ± 7.066) 0.524 42 (24.041 ± 4.127) 0.072
More than twice a week 21 (83.191 ± 8.328) 17 (22.264 ± 2.970)
Monthly income(PKR)
Less than 50,000 19 (82.737 ± 6.657) 0.316 17 (23.412 ± 4.380) 0.892
More than 50,000 46 (84.674 ± 7.763) 42 (23.577 ± 3.730)

Table 2: Blood Sugar Level (BSL), Body – Mass Index (BMI) and their association with various risk factors in male par-
ticipants. N: number of participants.

BSL BMI
BSL – P value BMI – P value
N (mean BSL ± STD) N (mean BMI ± STD)
Family History of DM
14 (79.857 ± 6.602)
No 0.016 13 (22.461 ± 3.200) 0.185
29 (85 ± 6.228)
Yes 27 (23.971 ± 3.458)
No. of hours spent sedentary
Less than 3 hours 14 (83.930 ± 5.980) 0.666 12 (23.315 ± 2.857) 0.829
More than 3 hours 29 (80.035 ± 6.920) 28 (23.550 ± 3.670)
Exercise hours per week
Less than 4 29 (84.103 ± 6.494) 0.331 27 (23.873 ± 3.846) 0.341
More than 4 13 (81.846 ± 6.926) 12 (22.863 ± 2.297)
No. of restaurant visits
Less than twice per week 25 (83.429 ± 6.665) 0.884 25 (24.201 ± 3.407) 0.080
More than twice a week 18 (83.5 ± 6.555) 15 (22.278 ± 3.169)
Monthly income(PKR)
Less than 50,000 14 (83.429 ± 6.665) 0.944 13 (22.642 ± 3.861) 0.326
More than 50,000 29 (83.276 ± 6.643) 27 (23.883 ± 3.171)

Table 3: Blood Sugar Level (BSL), Body – Mass Index (BMI) and their association with various risk factors in female parti-
cipants. N: number of participants.

BSL BMI
BSL – P value BMI – P value
N (mean BSL ± STD) N (mean BMI ± STD)
Family History of DM
No 9 (85.444 ± 6.247) 0.929 7 (23.535 ± 4.189) 0.945
Yes 13 (85.769 ± 10.631) 12 (23.691 ± 5.377)

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MUAAZ WASEEM, FARAZ AHMED BOKHARI, MUHAMMAD AAKIF JALAL, et al

BSL BMI
BSL – P value BMI – P value
N (mean BSL ± STD) N (mean BMI ± STD)
No. of hours spent sedentary
Less than 3 hours 4 (84.000 ± 11.776) 0.753 3 (20.776 ± 6.096) 0.466
More than 3 hours 17 (86.118 ± 8.788) 15(23.968 ± 4.709)
Exercise hours per week
Less than 4 15 (86.733 ± 9.975) 0.355 14 (22.480 ± 4.358) 0.249
More than 4 6 (83.167 ± 6.616) 4(26.783 ± 5.936)
No. of restaurant visits
Less than twice per week 19 (86.316 ± 7.303) 0.680 17 (23.807 ± 5.112) 0.240
More than twice a week 3 (81.333 ± 17.954) 2 (22.162 ± 0.732)
Monthly income(PKR)
Less than 50,000 5 (80.800 ± 6.979) 0.138 4 (25.915 ± 5.636) 0.397
More than 50,000 17 (87.059 ± 9.093) 15 (23.025 ± 4.643)

Discussion fically (≤ 25 years).13

The role of family history as a risk for diabetes is
The increase in incidence of diabetes in developing also well established. A history of both Type 1 and
countries is expected to be much more than in deve- Type 2 Diabetes Mellitus (T2DM), have an effect on
loped countries (170% vs. 42% over 1995 – 2025 year phenotype of patients with T2DM suggesting a genetic
period).6 An alarming factor is the incidence of diabe- interaction between both types14 and in the present
tes in youth. According to a 2006 research, 35% of US study, blood sugar level was notably higher in male
adults, aged 20 years or older, had pre diabetes, in ad- participants with family history of diabetes. In fema-
dition to about 2.8 million adolescents who were also les, however, similar trend was not observed possibly
found to have the same.7 In China, a 2010 study esti- due to smaller sample size.
mated that 92.4 million adults (20 years of age or
‘The prevalence of isolated impaired glucose tole-
older) had diabetes. In addition, 148.2 million adults
rance (i-IGT) is higher in women than in men, whereas
(15.5%) had pre diabetes and the prevalence, in ages
the prevalence of isolated impaired fasting glycaemia
20 – 39 years, of diabetes and pre diabetes was 3.2%
(i-IFG) is higher in men than in women’.15 In our stu-
and 9.0% respectively.8 In a 2002 survey, the overall
dy we didn’t find any pre diabetic or with impaired
diabetes prevalence in Australia was 7.4%, and an
fasting glycaemia.
additional 16.4% had pre diabetes. In the youngest age
The data on prevalence in youth (18 – 25 years) is
group in that study (25 – 34 years), 5.7% of subjects
scarce. If we look at Asia, in China, the prevalence of
had abnormal glucose tolerance.9 A 2006 study estima-
IFG in 20 – 39 years is 9.0%.8 A study on 280 ove-
ted the numbers of Korean adults (aged >20 years)
rweight Japanese children showed 19.2% prevalence
with diabetes or IFG to be 2.6 and 8.1 million, respe-
of pre diabetes.16 The project of Rawalpindi showed
ctively.10
0.88% prevalence in the youth (≤ 25 years).13 There
The situation in South Asia is not different. In Sri was also a research done on school-going children in
Lanka a survey showed one in five adults to have eith- India (aged 5 – 10 years) which showed a 3.7% preva-
er diabetes or pre-diabetes.11 A study by Indian Coun- lence of pre diabetes.17
cil of Medical Research (ICMR – INDIAB) predicted The biggest limitation of this study was its sample
that by 2011, 4 major Indian states would have 0.13 to size and setting. A large sample from different colle-
9.2 million people suffering from pre diabetes, while it ges may show significant findings about the status of
projected that 77.2 million people would contract pre pre diabetes and diabetes in young medical students. In
diabetes in the whole of India.12 addition, inclusion of Oral Glucose Tolerance Test can
A study in a selected urban population of Rawal- give more convincing findings. Data on prevalence of
pindi, Pakistan showed 5.61% prevalence of pre-dia- pre diabetes in youth in South Asia is scarce. The high
betes overall and 0.88% prevalence in the youth speci- incidence of diabetes in developing countries under-

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 PRE DIABETES IN YOUNG MEDICAL STUDENTS

lines the need to explore prevalence of pre diabetes in lence of diabetes and impaired glucose tolerance: the
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Survey 2001. Diabetes care, 2006; 29 (2): 226-31.
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