The Prevalence of Diabetes and Prediabetes Among Elementary School Children in Birjand

authors:

avatar Tayyebeh Chahkandi 1 , avatar Fatemeh Taheri ORCID 1 , * , avatar Toba Kazemi 1 , avatar Bita Bijari 1

Department of Pediatrics, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
Iranian Journal of Pediatrics: Vol.25, issue 1
published online: February 15, 2015
article type: Research Article
received: December 15, 2013
accepted: November 11, 2014
DOI: https://doi.org/10.5812/ijp.183

how to cite: Chahkandi T, Taheri F, Kazemi T, Bijari B. The Prevalence of Diabetes and Prediabetes Among Elementary School Children in Birjand. Iran J Pediatr. 2015;25(1): -. https://doi.org/10.5812/ijp.183.

Abstract

Background:

Diabetes is associated with increased cardiovascular disease, mortality and morbidity.

Objectives:

The present study aimed at assessing fasting blood sugar (FBS) in elementary school students in Birjand, 2012.

Materials and Methods:

This cross-sectional and descriptive study was done on 1530 elementary school students who had been selected through multiple cluster sampling. FBS of these students was tested applying the enzymatic process. The obtained data was analyzed by means of SPSS software (v15) and statistical tests t and X2.

Results:

In this study, 833 girls and 697 boys were evaluated. Mean FBS of the whole study population was 86.9 ± 8.8 mg/dL; FBS was higher in boys compared to girls. FBS of 1453 (95%) children was < 100 mg/dL, the mean being 85.8 ± 6.8 mg/dL. FBS of 698 (45.6%) students of the above population was 86-99 mg/dl. It was 100-125 mg/dL in 72 (4.7%) individuals. Five (0.3%) students had FBS >126 mg/dL. Mean FBS increased in proportion to age, which was statistically significant.

Conclusions:

Although the prevalence of diabetes is not considerable; however, based on the relatively high portion of those children with high degree of blood glucose in the range in which the risk of diabetes and prediabetes in the following years rises dramatically, the need for further care of health authorities, an extensive screening activity, and undertaking intervening measures to prevent the epidemic of diabetes and consequently cardiovascular disease is emphasized.

1. Background

It is certain that the main cause of cardiovascular diseases (CVD) backs to early childhood (1-4). Impairment in the metabolism of carbohydrates leads to increased mortality and morbidity of cardiovascular diseases (5). The number of type II diabetic patients is increasing in the world, and many of them remain undiagnosed. The cardiovascular risk of undiagnosed diabetes is the same or higher than the previously diagnosed ones (6). Metabolic syndrome is a set of major risk factors for CVD with high blood glucose being one of them (7-10). Obesity, particularly central obesity is associated with insulin resistance (10-12). During recent decades, the prevalence of obesity in children is increasing and it is expected that impairment in carbohydrate metabolism would be more prevalent (8, 9, 13). Therefore, identifying children susceptible to abnormal carbohydrate metabolism, which has a decisive role in CVD or diabetes, is of vital importance (14).

Those persons having impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), who are at higher risk of diabetes, are called "prediabetics" (15-17). A "prediabetic" state is an intermediary and returnable condition of carbohydrate metabolism disorder before getting diabetes II (18). In other words, IFG and IGT are intermediate stages of disordered carbohydrate metabolism between normal glucose homeostasis and diabetes (15). Identifying children at risk and taking intervening measures can have an effective role in preventing CVD and reducing long-term mortality and morbidity (19).

2. Objectives

Regarding that there was no documented data on blood glucose of Birjandi children, the present study aimed at determining the prevalence of diabetes and prediabetes of this population.

3. Materials and Methods

This cross-sectional and descriptive study was done on 1530 elementary students aged 6-11 years. Proportional multiple cluster method was applied for choosing the samples. According to the socioeconomic levels, Birjand city is divided into five regions. In following, state-run elementary schools of each region as well as private schools were evaluated. Considering the distribution of schools in different districts of the city, 10 elementary schools for girls and boys were selected. Then, with respect to the population of the respective school and the class, a number of students were chosen from each class. Based on the above procedure, 1700 students were chosen and a demographic questionnaire together with a consent form was sent to their parents. The parents were asked to fill the questionnaire and the consent forms at home and return it to the school. We received 1530 completed questionnaires. According to the plan, the students were referred to a diagnostic clinic where a blood sugar sample after a 12-hour fasting was taken from each individual. The obtained samples were immediately centrifuged and sugar levels determined through enzymatic procedure using German Rosh kits. The standard by which impairment in FBS would be identified was that of ADA, i.e. FBS ≥100 mg/dL, but < 125 mg/dL. FBS ≥126 mg/dL was accounted for diabetes (20). Statistical analysis was performed by means of SPSS software (v: 15) and comparison of qualitative variables was made using X2; and prevalence was mentioned in percentage, α≤0.05 was taken as the significant level.

4. Results

The elementary students studied consisted of 1530 cases; 833 (54.4%) girls and 697 (45.6%) boys. Mean age of the children was 9.1 ± 1.4 years. The age range was 6 to 11.9 years. Mean FBS of the whole population was 86.9 ± 8.8 mg/dL, 87.9 ± 7.6 mg/dL in boys and 86.1 ± 9.6 mg/dL in girls and this difference was statistically significant (P < 0.001) (Table 1). Prevalence of diabetes was 0.3% (i.e. 0% in males and 0.6% in females) and Prevalence of prediabetes was 4.7% (i.e. 5.5% in males and 4.1% in females). In 1453 (95%) cases including 794 (95.3%) of girls and 659 (94.3%) of boys, FBS was < 100 mg/dL (mean: 85.8 ± 6.8). FBS of 95% of the students in this group was 79-92.7 mg/dL, i.e. FBS of 755 (49.3%) cases was < 86 mg/dL and that of 698 (45.6%) individuals was 86-99 mg/dL. In 72 (4.7%) subjects of the whole population, including 34 (4.1%) of females and 38 (5.5%) of males whose mean age was 9.3 years, FBS was 100-125 mg/dL which was not statistically significant (Table 2).

Relationship between age and prevalence of diabetes and prediabetes was not significant, nor in girls neither in boys (Table 2). Among the students, 5 (0.3%) girls whose mean age was 9.8 years had an FBS >126 mg/dL (mean: 151.8 ± 15.4). Mean FBS in the whole population was proportional to age, which was statistically significant (P< 0.001). Figure 1 shows mean and 95% CI of mean FBS accounting for age and sex.

Table 1.

Mean Fasting Blood Glucose in Our Subjects for Age and Sex a

MalesFemalesP Value
Age, yr
685.94 ± 6.8483.40 ± 8.280.05
785.55 ± 7.7083.46 ± 11.450.07
887.55 ± 7.2885.22 ± 7.730.006
988.76 ± 7.7587.10 ± 8.940.08
1089.42 ± 7.2088.92 ± 7.2700.6
1190.68 ± 7.5987.24 ± 11.260.006
Total87.99 ± 7.6086.13 ± 9.65< 0.001

a Data are presented as mean ± SD.

Table 2.

Distribution of FBS < 100, 100 ≤FBS ≤ 125 and FBS ≥ 126 in Primary School Children, Birjand, Iran a,b

Males 697 (45.6)Females 833 (54.4)
FBS < 100 (mg/dL)100 ≤ FBS ≤ 125 (mg/dL)FBS ≥ 126 (mg/dL)P ValueFBS < 100 (mg/dL)100 ≤ FBS ≤ 125 (mg/dL)FBS ≥ 126 (mg/dL)P Value
Age, yr0.120.55
656 (98.2)1 (1.8)0 (0)69 (94.5)4 (5.5)0 (0)
7133 (96.2)5 (3.8)0 (0)125 (94)7 (5.3)1 (0.8)
8132 (95.7)6 (4.3)0 (0)193 (97.5)5 (2.5)0 (0)
9131 (92.3)11 (7.7)0 (0)158 (94)9 (5.4)1 (0.6)
10149 (93.1)11 (6.9)0 (0)169 (94.9)6 (3.4)3 (1.7)
1158 (90.6)6 (9.4)0 (0)80 (96.4)3 (3.6)0 (0)
Total659 (94.5)38 (5.5)0 (0)794 (95.3)34 (4.1)5 (0.6)

a Abbreviations: FBS, fasting blood sugar.

b Data are presented as No. (%).

Comparison of Mean FBS for Age and Sex
Comparison of Mean FBS for Age and Sex
Figure 1.

Comparison of Mean FBS for Age and Sex

Acknowledgements

References

  • 1.

    Rodrigues AN, Abreu GR, Resende RS, Goncalves WL, Gouvea SA. Cardiovascular risk factor investigation: a pediatric issue. Int J Gen Med. 2013;6:57-66. [PubMed ID: 23515212]. https://doi.org/10.2147/IJGM.S41480.

  • 2.

    Laitinen TT, Pahkala K, Magnussen CG, Viikari JS, Oikonen M, Taittonen L, Mikkila V, Jokinen E, Hutri-Kahonen N, Laitinen T, Kahonen M, Lehtimaki T, Raitakari OT, Juonala M, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2012;125(16):1971-8. [PubMed ID: 22452832]. https://doi.org/10.1161/CIRCULATIONAHA.111.073585.

  • 3.

    Hartiala O, Magnussen CG, Kajander S, Knuuti J, Ukkonen H, Saraste A, Rinta-Kiikka I, Kainulainen S, Kahonen M, Hutri-Kahonen N, Laitinen T, Lehtimaki T, Viikari JS, Hartiala J, Juonala M, Raitakari OT, et al. Adolescence risk factors are predictive of coronary artery calcification at middle age: the cardiovascular risk in young Finns study. J Am Coll Cardiol. 2012;60(15):1364-70. [PubMed ID: 22981553]. https://doi.org/10.1016/j.jacc.2012.05.045.

  • 4.

    Kamphuis CB, Turrell G, Giskes K, Mackenbach JP, van Lenthe FJ. Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up. BMC Public Health. 2012;12:1045. [PubMed ID: 23217053]. https://doi.org/10.1186/1471-2458-12-1045.

  • 5.

    Matheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens. 2013;2013:653789. [PubMed ID: 23533715]. https://doi.org/10.1155/2013/653789.

  • 6.

    Hadaegh F, Bozorgmanesh MR, Ghasemi A, Harati H, Saadat N, Azizi F. High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study. BMC Public Health. 2008;8:176. [PubMed ID: 18501007]. https://doi.org/10.1186/1471-2458-8-176.

  • 7.

    Bouzas I. Metabolic syndrome during adolescence. Adolesc Saude. 2011;8(3):54-62.

  • 8.

    Chen F, Wang Y, Shan X, Cheng H, Hou D, Zhao X, Wang T, Zhao D, Mi J, et al. Association between childhood obesity and metabolic syndrome: evidence from a large sample of Chinese children and adolescents. PLoS One. 2012;7(10). [PubMed ID: 23082159]. https://doi.org/10.1371/journal.pone.0047380.

  • 9.

    Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375(9727):1737-48. [PubMed ID: 20451244]. https://doi.org/10.1016/S0140-6736(10)60171-7.

  • 10.

    Afkhami-Ardekani M, Zahedi-Asl S, Rashidi M, Atifah M, Hosseinpanah F, Azizi F. Incidence and trend of a metabolic syndrome phenotype among Tehranian adolescents: findings from the Tehran Lipid and Glucose Study, 1998-2001 to 2003-2006. Diabetes Care. 2010;33(9):2110-2. [PubMed ID: 20519656]. https://doi.org/10.2337/dc09-0023.

  • 11.

    Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350(23):2362-74. [PubMed ID: 15175438]. https://doi.org/10.1056/NEJMoa031049.

  • 12.

    Steinberger J, Daniels SR, American Heart Association Atherosclerosis H, Obesity in the Young C, American Heart Association Diabetes C. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003;107(10):1448-53. [PubMed ID: 12642369].

  • 13.

    Taheri F, Kazemi T. Prevalence of Overweight and Obesity in 7 to 18 Year-0ld Children in Birjand/Iran. Iran J Pediatr. 2009;19(2):135-40.

  • 14.

    Morrison JA, Glueck CJ, Wang P. Childhood risk factors predict cardiovascular disease, impaired fasting glucose plus type 2 diabetes mellitus, and high blood pressure 26 years later at a mean age of 38 years: the Princeton-lipid research clinics follow-up study. Metabolism. 2012;61(4):531-41. [PubMed ID: 22001337]. https://doi.org/10.1016/j.metabol.2011.08.010.

  • 15.

    Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes. 2009;10 Suppl 12:3-12. [PubMed ID: 19754613]. https://doi.org/10.1111/j.1399-5448.2009.00568.x.

  • 16.

    American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35 Suppl 1:S64-71. [PubMed ID: 22187472]. https://doi.org/10.2337/dc12-s064.

  • 17.

    Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 2002;19(9):708-23. [PubMed ID: 12207806].

  • 18.

    Wang G, Arguelles L, Liu R, Zhang S, Brickman WJ, Hong X, Tsai HJ, Wang B, Xing H, Li Z, Xu X, Wang X, et al. Tracking blood glucose and predicting prediabetes in Chinese children and adolescents: a prospective twin study. PLoS One. 2011;6(12). [PubMed ID: 22163315]. https://doi.org/10.1371/journal.pone.0028573.

  • 19.

    Prasad AN. Type 2 diabetes mellitus in young need for early screening. Indian Pediatr. 2011;48(9):683-8. [PubMed ID: 21992902].

  • 20.

    Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS. Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med. 2010;164(2):124-8. [PubMed ID: 20124140]. https://doi.org/10.1001/archpediatrics.2009.268.

  • 21.

    Nguyen QM, Srinivasan SR, Xu JH, Chen W, Kieltyka L, Berenson GS. Utility of childhood glucose homeostasis variables in predicting adult diabetes and related cardiometabolic risk factors: the Bogalusa Heart Study. Diabetes Care. 2010;33(3):670-5. [PubMed ID: 20009096]. https://doi.org/10.2337/dc09-1635.

  • 22.

    O'Malley G, Santoro N, Northrup V, D'Adamo E, Shaw M, Eldrich S, Caprio S, et al. High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation. Diabetologia. 2010;53(6):1199-209. [PubMed ID: 20204321]. https://doi.org/10.1007/s00125-010-1693-0.

  • 23.

    Kazemi T, Sharifzadeh GR, Zarban A, Fesharakinia A, Rezvani MR, Moezy SA. Risk factors for premature myocardial infarction: a matched case-control study. J Res Health Sci. 2011;11(2):77-82. [PubMed ID: 22911956].

  • 24.

    Kazemi T, Sharifzadeh G, Zarban A, Fesharakinia A. Comparison of components of metabolic syndrome in premature myocardial infarction in an Iranian population: a case -control study. Int J Prev Med. 2013;4(1):110-4. [PubMed ID: 23411742].

  • 25.

    Dehghani Firoozabadi M, Kazemi T, Sharifzadeh G, Dadbeh S, Dehghan P. Stroke in birjand, iran: a hospital-based study of acute stroke. Iran Red Crescent Med J. 2013;15(3):264-8. [PubMed ID: 23984011]. https://doi.org/10.5812/ircmj.4282.

  • 26.

    Barzin M, Hosseinpanah F, Saber H, Sarbakhsh P, Nakhoda K, Azizi F. Gender Differences Time Trends for Metabolic Syndrome and Its Components among Tehranian Children and Adolescents. Cholesterol. 2012;2012:804643. [PubMed ID: 22577529]. https://doi.org/10.1155/2012/804643.

  • 27.

    Chahkandi T, Taheri F, Bijari B, et al. Prevalence of high normal FBS and prediabetes among adolescents in Birjand, East of Iran, 2012. J Educ Health Promot.

  • 28.

    Tfayli H, Arslanian S. The challenge of adolescence hormonal changes and sensitivity to insulin. Diabetes Voice. 2007;52(special issue):28-30.

  • 29.

    Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001;50(11):2444-50. [PubMed ID: 11679420].