Background: Prediabetes is a condition characterized by elevated blood glucose levels below the threshold for diabetes diagnosis but associated with an increased risk of progression to type 2 diabetes and related complications. The aim of this study is to demonstrate prevalence of predibetes and its associated risk factors among Nile College Students, Sudan.

Materials and Methods: This observational, descriptive, cross-sectional study was conducted at Nile College, Khartoum North, Sudan, involving 303 students aged 16–30 years from all programs. Participants completed a structured questionnaire covering personal data, medical history, lifestyle factors, and family history. Fasting blood glucose (FBG) was measured, and body mass index (BMI) was calculated. Data were analyzed using SPSS version 22.

Results: Among the 303 participants, 66.3% were female, and 33.7% were male. The overall prevalence of prediabetes was 35.6. The most significant risk factors for prediabetes were a family history of diabetes (88%), elevated BMI, and a sedentary lifestyle. Approximately 39.5% of prediabetic students reported insufficient fruit and vegetable intake, while 10% were smokers.

Conclusion: The high prevalence of prediabetes among Nile College students underscores the need for early screening, lifestyle interventions, and increased awareness to prevent progression to type 2 diabetes. Addressing modifiable risk factors, such as diet and physical activity, is essential for effective management and prevention.

Diabetes mellitus (DM) is a significant global health issue, often undiagnosed until complications arise [1]. Type 2 diabetes mellitus (T2DM) is linked to increased risks of cardiovascular disease (CVD) and microvascular complications, which can begin before diagnosis, making early detection vital [2]. Prediabetes is a condition characterized by elevated blood glucose levels below the threshold for a diagnosis of diabetes but associated with a higher risk of developing diabetes. Impaired glucose tolerance (IGT) (2-h glucose 7.8–11.0 mol/L [140–199 mg/dL]) and impaired fasting glucose (IFG) (fasting glucose 6.1–6.9 mmol/L [110–125 mg/dL]), based on the World Health Organization (WHO) criteria, are commonly used to define prediabetes [3]. People with prediabetes are defined by the presence of impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) [4]. According to WHO, diabetes is diagnosed with fasting plasma glucose (FPG) ≥ 126 mg/dL, 2-hour post-load glucose ≥ 200 mg/dL, or HbA1c ≥ 6.5% [5]. In the U.S., 33.9% of adults have prediabetes, with higher prevalence among those aged ≥ 65 years, though only 11.6% are aware of their condition [6]. Premenopausal women face growing rates of prediabetes and cardiovascular risks, emphasizing the need for early screening [7]. Similarly, youth with obesity and risk factors should undergo dysglycemia screening [8]. Prediabetes often coexists with conditions like obstructive sleep apnea, amplifying cardiovascular mortality risk [9]. Studies show diverse prevalence rates globally, such as 18.7% among young Saudi females (ADA criteria) [10], 14.4% in Pakistan [12], and significant overlap with tuberculosis in India [11]. In France, while rates are declining, about 25% of diabetes cases remain undiagnosed [13]. The coexistence of prediabetes and prehypertension signals a rising noncommunicable disease burden [14]. Addressing prediabetes through early intervention is key to reducing its progression and associated complications [15]. The aim of this study is to demonstrate prevalence of predibetes and its associated risk factors among Nile College Students, Sudan.

An observational, descriptive, cross-sectional study was conducted at Nile College, Khartoum North, Sudan, during 1 May till 31 July 2015 All students provided informed consent, and their socio-demographic and clinical data (weight, height and diabetes history) were collected using standard questionnaires [22]. Blood samples were collected from students enrolled in all academic programs, including Medicine, Dentistry, Pharmacy, Medical Laboratory Science, Nursing, Computer Information Systems, Business Administration, Accounting and Finance, and the Medical Information Systems Diploma Program. The study included 303 male and female students aged 16 to 30 years, representing all nationalities and academic programs. Students with a known history of diabetes were excluded. A total of 350 blood samples were initially collected, but 47 samples were excluded due to missing key data, resulting in a final sample covering 20% of the total student population (1,800 students) across the eight programs. The sample included 120 students from the Bachelor of Medicine and Surgery (MBBS) program and proportional representation from other programs. Stratified simple random sampling ensured representation from all programs. Based on the World Health Organization (WHO) criteria, impaired fasting glucose (IFG) (fasting glucose 6.1–6.9 mmol/L [110–125 mg/dL]), were considered predibetic [3]. 

Three hundred and three of Nile College students completed the study questionnaire. Regarding fasting blood glucose levels, 64.4% of the participants were normoglycemic, while 35.6% were pre-diabetic, so the prevalence of pre-diabetes was 35.6 % (Table 1). The student population comprised 40% studying medicine and 60% enrolled in other programs (Figure 1). Females made up 66.3% of the participants, while males accounted for 33.7% (Figure 2). Nearly 57% of the students were between 19 and 21 years old, followed by 21.5% aged 16–18 years, 19.1% aged 22–24 years, 2.3% aged 25–27 years, and only 0.3% aged 28–30 years (Figure 3). Body Mass Index (BMI) measurements revealed that 57.1% of participants had a normal BMI (18.5–24.9), 21.1% were overweight (BMI 25.0–29.9), and 16.8% were obese (BMI 30.0–34.9). A small percentage, 5%, had a BMI below 18.4, classifying them as underweight (Figure 4). 88.1% of participants reported having a family history of diabetes, with 40% of those cases attributed to their fathers (Table 2). Socioeconomic status was predominantly moderate, with 80% of participants belonging to this group, while 15% were categorized as high socioeconomic status, and 5% as low. Lifestyle habits showed that 12% of the participants were smokers. In terms of dietary and lifestyle patterns, 10% of pre-diabetics were smokers. 35% did not engage in regular physical exercise. Additionally, 39.5% of participants who consumed fruits and vegetables less than three times per week were pre-diabetic. Significant correlations were observed between BMI and fasting blood glucose levels, as well as between marital status and fasting blood glucose levels, with p-values of 0.000 and 0.009, respectively (Table 3, Figure 5). These results underscore the high prevalence of pre-diabetes among the student population and highlight the critical role of lifestyle factors such as physical activity, diet, and BMI in influencing blood glucose levels.

Table 1: Fasting Blood Glucose among all participants (N=303)

Figure 1: Participants in all programs (N=303)

Figure 2: Gender among all participants (N=303)

Figure 3: Age Group among all participants (N=303)

Figure 4: Body Mass Index among all participants (N=303)

Table 2: Family History of Diabetes of all participants (N=303)

P value = 0.000

Table 3: Fasting Blood Glucose and body mass index BMI) of all participants (N=303)

                                                                P value = 0.009

Figure 5: Fasting Blood Glucose and marital status of all participants (N=303)

According to our knowledge, this study is the first to investigate the prevalence of prediabetes among students at a Sudanese higher education institution, specifically Nile College. The findings provide important baseline data, with the prevalence of prediabetes among the participants being 35.6%. This aligns with a study conducted in the western suburbs of Paris, where prediabetes and undiagnosed diabetes were reported among subjects with cardiovascular risk factors based on the American Diabetes Association (ADA) criteria [16]. 

Prediabetes is a known risk factor for developing type 2 diabetes mellitus (T2DM) and is associated with increased risk of cardiovascular events and ischemic stroke. Studies suggest that elevated fasting plasma glucose and 2-hour postload glucose levels are predictors of stroke, with postload glucose levels being particularly significant [15]. Given the high prevalence of prediabetes among Nile College students, early identification and intervention are crucial.

Effective management of prediabetes can delay or even prevent progression to diabetes [16,17]. Lifestyle modifications, including increased physical activity and improved dietary habits, are central to reducing the risk of diabetes [16,18]. Pharmacological options such as metformin, acarbose, GLP-1 receptor antagonists, and thiazolidinediones have also shown efficacy in decreasing diabetes incidence in individuals with prediabetes [16,19,20,21].

Our findings highlight the urgent need for proactive screening and prevention programs targeting prediabetes among university students in Sudan. Incorporating lifestyle education, promoting physical activity, and providing nutritional guidance could significantly reduce the burden of prediabetes and its associated risks in this population.

Limitations

Our study has an important value in prophylaxis of diabetes mellitus. We hope to help people at risk of diabetes mellitus to be protected from this disease by known ways of preventing obesity as example of one of diabetes risk factor.   

This study reveals a high prevalence of prediabetes (34.7%) among Nile College students, driven by factors like family history, elevated BMI, sedentary lifestyles, and poor dietary habits. Early detection and prevention are essential to halt progression to type 2 diabetes and reduce associated risks. Lifestyle modifications, including improved diet and physical activity, along with targeted interventions, are critical to addressing this health concern in young populations.