|Year : 2017 | Volume
| Issue : 1 | Page : 69-75
Prevalence of diabetes mellitus and impaired glucose tolerance among adolescents in Menoufia governorate, Egypt
Rabie E Al Bahnasy, Omiyma A Mahrous, Hewaida M El Shazli, Hala M Gabr, Reda A Ibrahem, Shaimaa S Soliman MSc
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||09-Aug-2015|
|Date of Acceptance||20-Sep-2015|
|Date of Web Publication||25-Jul-2017|
Shaimaa S Soliman
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, 32951
Source of Support: None, Conflict of Interest: None
The aim of this study was to estimate the prevalence and risk factors of diabetes mellitus (DM) and impaired glucose tolerance among adolescents in Menoufia governorate.
DM is a group of metabolic diseases characterized by elevated blood glucose levels (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Type 1 diabetes is the most common type of diabetes during childhood and adolescence. Most cases of type 1 diabetes are due to destruction of the pancreatic β-cells by T-cells (white blood cells concerned with the immune system).
Patients and methods
This cross-sectional study was carried out on 1150 adolescents in two districts in Menoufia governorate. The participants were subjected to fasting glucose, 2 h-postprandial blood glucose testing, and anthropometric measurements.
This study showed that 0.6% of the studied adolescents had DM, 4.1% had impaired fasting hyperglycemia, and 2.4% of them had impaired glucose intolerance. Overweight and moderate obesity were found in 25% of the participants and were highly correlated (P < 0.01) to abnormal blood glucose level.
As diabetes among adolescents is a rising epidemic, this work was carried out on 1150 adolescents in Menoufia governorate to study the epidemiology of DM. The study revealed that 0.6% of the studied group had DM, 4.1% had impaired fasting hyperglycemia, and 2.4% of them had impaired glucose intolerance. Overweight and moderate obesity are major risk factors for abnormal blood glucose level. Excessive and nocturnal urination were the most common symptoms encountered by adolescents suffering from diabetes as 57.1% of diabetic adolescents had either one of them.
Keywords: blood sugar, diabetes mellitus, epidemiology, insulin, obesity, prevalence
|How to cite this article:|
Al Bahnasy RE, Mahrous OA, El Shazli HM, Gabr HM, Ibrahem RA, Soliman SS. Prevalence of diabetes mellitus and impaired glucose tolerance among adolescents in Menoufia governorate, Egypt. Menoufia Med J 2017;30:69-75
|How to cite this URL:|
Al Bahnasy RE, Mahrous OA, El Shazli HM, Gabr HM, Ibrahem RA, Soliman SS. Prevalence of diabetes mellitus and impaired glucose tolerance among adolescents in Menoufia governorate, Egypt. Menoufia Med J [serial online] 2017 [cited 2020 Feb 28];30:69-75. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/69/211493
| Introduction|| |
Glucose is the major metabolic fuel of mammals (except ruminants) and a universal fuel of the fetus. It is the precursor for the synthesis of all other carbohydrates in the body, including glycogen for storage, ribose and deoxyribose in nucleic acids, galactose in lactose of milk, in glycolipids, and in combination with protein in glycoproteins and proteoglycans. Diseases associated with carbohydrate metabolism include diabetes mellitus (DM), galactosemia, glycogen storage diseases, and lactose intolerance .
The WHO  and American Diabetes Association (ADA) , define the term 'DM' as a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of DM include long-term damage, dysfunction, and failure of various organs. Diagnosis is made by the presence of classic symptoms of hyperglycemia and an abnormal blood test, a plasma glucose concentration greater than and equal to 7 mmol/l (or 126 mg/dl) or greater than and equal to 11.1 mmol/l (or 200 mg/dl) 2 h after a 75 g glucose drink. There are two main types of diabetes:
- Type 1 diabetes: It usually develops during childhood and adolescence and patients require lifelong insulin injections for survival
- Type 2 diabetes: It usually develops during adulthood and is related to obesity, lack of physical activity, and unhealthy diets.
Intermediate states of hyperglycemia 
- Impaired fasting glucose (IFG): It is a state of higher-than-normal fasting blood (or plasma) glucose (FBG) concentration, but lower than the diagnostic cutoff for diabetes 
- Impaired glucose intolerance (IGT): It is a state of higher-than-normal blood (or plasma) glucose concentration 2 h after 75 g oral glucose load, but less than the diagnostic cutoff for diabetes.
Impaired fasting glucose
IFG was diagnosed when fasting plasma glucose was greater than or equal to 6.1 mmol/l (110 mg/dl) but less than 7 mmol/l (126 mg/dl) as per WHO 1999 criteria. ADA has chosen a lower cutoff of 5.6 mmol/l or 100 mg/dl .
Impaired glucose intolerance
IGT was diagnosed when blood glucose levels were greater than or equal to 7.8 mmol/l (140 mg/dl) but less than 11.1 mmol/l (200 mg/dl) 2 h after administering a drink containing 75 g of glucose.
Adolescents (young people between the ages of 10 and 19 years) have specific health and development needs, and many face challenges that hinder their well-being, including poverty and a lack of access to health information and services . The manifest gulf in experience that separates younger and older adolescents makes it useful to consider this second decade of life as two parts: early adolescence (10–14 years) and late adolescence (15–19 years) . In Egypt, raised blood glucose represented 6.5% in the whole population , but there is lack of data about the prevalence of diabetes and impaired glucose tolerance among adolescents.
Social burden of diabetes mellitus
Adolescents with diabetes may be at a greater risk of being 'bullied' compared with their healthy peers , resulting in social anxiety and loneliness. Bullied adolescents may avoid interactions and be denied positive social experiences . They may decide to 'hide' their diabetes or deny its existence. Many adolescents intentionally omit insulin regularly, and this may be related to denial, fear of social stigma, weight gain, or fear of 'hypos'. Helping adolescents to recognize their internal conflicts would be beneficial in improving the quality of life and achieving good diabetes control .
This difficult period for the adolescents with diabetes is confounded as it coincides with the transition of care from pediatric care to adult care services. During the transition, there is a higher risk for loss of follow-up, with most adolescents experiencing the transition as traumatic .
Family counseling is an important part of prediabetes management, which includes effective diet, exercise, behavioral changes, and lifestyle modifications .
| Aim|| |
This study aimed to estimate the prevalence of DM and impaired glucose tolerance among adolescents in Menoufia governorate.
| Patients and Methods|| |
This cross-sectional, descriptive analytical study was conducted from 1 November 2012 to end of July 2015, with the practical part conducted from the beginning of February 2013 to the end of March 2015, in Menoufia governorate, Egypt. The sample size was calculated using Epi Info 7 program .
Ethical points of the research:
- An approval from the medical ethics committee at Menoufia Faculty of Medicine was taken as a first step
- The participants simply were informed about the purpose of this study and the steps that will be carried out. Oral consent was obtained from every participant.
After exclusion of 300 invalid screening tests and 80 as a pilot study, the total studied sample became 1150 students. The studied sample was divided as two-thirds in the early adolescence stage and one-third in the late adolescence stage, but divided nearly equally between male and female populations.
All participants were came after overnight fasting on the day of examination. In a calm room (the room of the health visitor), all participants were subjected to history taking (including sociodemographic data, symptoms or signs of diabetes or impaired glucose tolerance and family history) and general medical examination. Standing height was measured without shoes, to the nearest 0.1 cm, using Harpenden stadiometer (Holtain Ltd, Crosswell, Crymych, UK), and weight was measured using a digital scale, to the nearest 0.1 kg, wearing light clothing and without shoes. BMI was calculated using the formula kg/m 2. SD scores for weight, height, and BMI were calculated.
The laboratory investigations included the following:
- Screening of the blood glucose was carried out using Rightest GS300 blood glucose strips (Bionime Corporation, Berneck, Switzerland) for checking on glucose levels in capillary whole blood from the fingertip, palm, and forearm for both FBG (after a 12 h overnight fast) or for 2 h-postprandial blood glucose (after ingestion of 75 g of glucose)
- The confirmatory test: This was conducted for any participant whose screening test result was positive for hyperglycemia. Blood glucose was determined using enzymatic colorimetric test, using Spinreact kit (Spain).
Kruskal–Wallis test was used for comparison of quantitative variables between more than two groups of not normally distributed data with Tamhane's test as post-hoc test. Student's t-test was used for comparison of the means of continuous quantitative parametric variables and the Mann–Whitney U-test for nonparametric variables. The c2 with Yates correction or/and Fisher's exact tests were used for comparing categorical variables. Odds ratio describes the probability that people who are exposed to a certain factor will have a disease compared with people who are not exposed to the factor. Pearson correlation was used to study the correlation between two quantitative variables.
Analysis was conducted with SPSS software (v. 20; SPSS Inc., Armonk, New York, USA).
| Results|| |
The sociodemographic criteria of the studied adolescents showed that the mean ± SD age of the studied group was 13.42 ± 2.40 years (range: 10–19 years). Five hundred and ninety (51.3%) of our participants were male, 607 (52.8%) of them were of urban residence, 480 (41.7%) of them were in primary education, and 378 (32.7%) reported that their families had enough income [Table 1].
|Table 1 Number and percentage distribution of the sociodemographic characteristics of the studied group|
Click here to view
There was no significant difference between male and female participants as regards the state of blood sugar either normal (52.0% male and 48.0% female), impaired fasting (38.3% male and 61.8% female), impaired 2 h-postprandial (40.7% male and 59.3% female), or diabetic (71.4% male and 28.6% female) (P > 0.05). There was no significant difference in age among adolescents with normal blood glucose (13.45 ± 2.38), IFG (13.19 ± 2.77), IGT (12.92 ± 2.36), and diabetic adolescents (13.00 ± 2.58).
From the different symptoms of diabetes, excessive and nocturnal urination were the most common symptoms encountered by adolescents suffering from diabetes, as 57.1% of diabetic adolescents had either one of them [Table 2] and [Table 3].
|Table 2 Comparison of the studied group (classified according to their fasting blood glucose) as regards the hyperglycemic symptoms and family history|
Click here to view
|Table 3 Comparison of the studied group (classified according to their 2 h postprandial blood glucose) as regards the hyperglycemic symptoms|
Click here to view
Family history of diabetes was present in 29.6% of the adolescents with fasting hyperglycemia and 58.8% of adolescents with 2 h postprandial hyperglycemia (P < 0.001 for both; odds ratio 3.77 and 13.61, respectively) [Table 2] and [Table 3].
The results of FBG testing revealed that 0.6% of the studied group was diabetic and 4.1% had impaired fasting glucose metabolism. Meanwhile, the results of the 2 h postprandial blood glucose testing gave the same prevalence of diabetes (0.6%) and 2.4% as the prevalence of impaired glucose tolerance [Figure 1] and [Figure 2].
|Figure 1: Percentage distribution of the fasting blood glucose status of the studied group.|
Click here to view
|Figure 2: Percentage distribution of the 2 h postprandial blood glucose status of the studied group.|
Click here to view
The incidence of overweight was 22.8%, whereas the incidence of moderate obesity was 2.2% in the studied group (totally 25.0%) [Figure 3].
There was a strong association between overweight and obesity and hyperglycemia as 96.7% of adolescents suffering from fasting hyperglycemia were in the weight category of overweight and moderate obesity, whereas 94.1% of those suffering from hyperglycemic 2 h postprandial blood glucose were in the same weight category (P < 0.01 for both) [Table 4] and [Table 5]. There was a significant positive correlation between BMI and both FBG and 2 h postprandial blood glucose (r = 0.11 and 0.12, respectively; P < 0.001 for both) [Table 6] and [Figure 4], [Figure 5].
|Table 4 Comparison of the studied group (classified according to their fasting blood glucose) as regards the personal risk factor|
Click here to view
|Table 5 Comparison of the studied group (classified according to their 2 h postprandial blood glucose) as regards the personal risk factor|
Click here to view
|Figure 4: Correlation between fasting blood glucose and BMI in the whole studied group.|
Click here to view
|Figure 5: Correlation between 2 h postprandial blood glucose and BMI in the whole studied group.|
Click here to view
| Discussion|| |
DM is a leading cause of death and disability worldwide . Its global prevalence was about 8% in 2011 and is predicted to rise to 10% by 2030. Nearly 80% of people with diabetes live in low-income and middle-income countries .
In the current study, it was found that the prevalence of diabetes in the studied group was 0.6% (based on fasting and 2 h postprandial blood glucose level). This is in agreement with the CDC National Diabetes Fact Sheet , which stated that diabetes is one of the most common diseases in school-aged children, as about 215 000 young people in the USA under the age of 20 years had diabetes in 2010. This represents 0.26% of all people in this age group [Figure 1] and [Figure 2].
In another study in the USA, Duncan  studied the prevalence of diabetes and impaired fasting glucose level among US adolescents at the National Health and Nutrition Examination Survey, 1999–2002. In the full sample, which was 4370 adolescents (aged 12–19 years), 0.5% [95% confidence interval (CI): 0.24–0.76%] of adolescents were reported as having diabetes.
This was also nearly similar to that stated by Hsia et al. , who conducted a retrospective cohort study that covered 8 years (1998–2005) of UK IMS Disease Analyzer data and found that the prevalence of diabetes was 0.34% in the age group of 12–18 years. In their study, they included all children and adolescents aged 0–18 years who received at least one antidiabetic drug prescription during the study period. Their data showed a steady increase in insulin use from 2.52 per 1000 (95% CI: 2.40–2.88) to 3.43 per 1000 children (95% CI: 3.39–3.83) in the 12–18-year-old group (P < 0.001).
In Ireland, one in every 600 children/adolescents has type 1 diabetes, which equals to 0.16% according to the Diabetes Federation of Ireland .
This study showed no significant difference between male and female population as regards the state of blood sugar. There was no significant difference in age among adolescents with normal blood glucose, IFG, IGT, or diabetic adolescents. This is in agreement with that stated by Duncan, who found that, in the subsample that included 1496 participants, 11.13% (95% CI: 8–14%) had impaired fasting glucose levels. Of them, 69% were male and 31% were female. There was no difference (P = 0.94) in age among diabetic patients (15.4 ± 0.6 years) and nondiabetic patients (15.4 ± 0.1 years). Age was not different (P = 0.83) among individuals having normal (15.4 ± 0.1 years) and impaired (15.4 ± 0.3 years) fasting glucose levels.
In this study, the overall prevalence of overweight and obesity in the studied group was 25.0% [Figure 3]. This is very close to that stated by UNICEF Egypt  on nutritional health status, which stated that 19% of male adolescents and 25% of female adolescents are above normal weight.
This percentage was also comparable to the results from the 2007 to 2008 National Health and Nutrition Examination Survey by Ogden et al.  in the USA, using measured heights and weights, which indicate that an estimated 16–17% of children and adolescents between 2 and 19 years of age had a BMI greater than or equal to the 95th percentile of the age-specific and sex-specific BMI – about double the number two decades ago.
| Conclusion|| |
This study that was conducted on 1150 adolescents revealed that 0.6% of the studied group had DM, 4.1% had IFG, and 2.4% of them had IGT. Excessive and nocturnal urination were the most common symptoms encountered by adolescents suffering from diabetes (57.1%). Family history of diabetes and abnormal BMI are significant alarms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lindhorst TK, Thisbe K Essentials of carbohydrate chemistry and biochemistry
[Chapter 2]. 3rd
ed. Weiheim: Wiley-VCH; 2007. pp. 15–28.
World Health Organization (WHO). Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation 1999. Part 1. Diagnosis and classification of diabetes mellitus Geneva: World Health Organization (WHO) 1999.
American Diabetes Association (ADA). Standards of medical care. Diabetes Care 2006; 29:s4–s42.
American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 28:S37–S42.
United Nations Children's Fund (UNICEF), 2011. The state of the world's children 2011. New York: United Nations Children's Fund (UNICEF), 2011; 2011.
Storch EA, Lewin A, Greffken GR. Peer victimization and psychological adjustment in children with type 1 diabetes. Clin Pediatr 2004; 43:467–472.
Storch EA, Heidgerken AD Greffken G. Bullying, regimen self-managment, and metabolic control in youth with type 1 diabetes. J Pediatr 2006; 16:784–787.
Snoek, FJ, Skinner TC. Psychological aspects of diabetes management. Medicine (Baltimore) 2006; 34:61–62.
Fleming E, Carter B, Gillibrand W. The transition of adolescents with diabetes from the children's health service into the adult health service: a review of the literature. J Clin Nurs 2002; 11:560–567.
Abou El-Ella S, Tawfik M, Hewait S. Early detection of diabetes mellitus in high-risk children. Menouf Med J 2014; 27:705–710.
Centers for Disease Control and Prevention (CDC). Epi Info™ 7; 2013. Available at: http://www.cdc.gov/epiinfo
. [Last accessed 2013 Jan 15].
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al
. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2095–2128.
Centers for Disease Control and Prevention (CDC). National diabetes fact sheet: general information and national estimates on diabetes in the United States
. Atlanta, GA: US Department of Health and Human Services 2011, Centers for Disease Control and Prevention; 2011.
Duncan G. Prevalence of diabetes and impaired fasting glucose levels among US Adolescents National Health and Nutrition Examination Survey, 1999–2002. Arch Pediatr Adolesc Med 2006; 160:523–528.
Hsia Y, Neubert A, Rani F, Viner R, Hindmarsh P, Wong I. An increase in the prevalence of type 1 and type 2 diabetes in children and adolescents: results from prescription data from a UK general practice database. Br J Clin Pharmacol 2009; 67:242–249.
Diabetes Federation of Ireland. Adolescents' views on diabetes. Report of the Teen Conference; Croke Park, Dublin; February 2009.
United Nations Children's Fund (UNICEF) Egypt. Demographic and Health Survey Brochures 2010, Nutrition Egypt United Nations Children's Fund (UNICEF) 2010
Ogden CL, Carroll MD, Curtin LR. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010; 303:242–249.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]