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*Corresponding author: E-mail: rajini.kurup@uog.edu.gy; 
 
 
 

Asian Journal of Immunology 
 
3(1): 39-45, 2020; Article no.AJI.55501 
 

 
 
 

 

A Pilot Study on Pre-diabetes and Associated 
Central Obesity among Students of University of 

Guyana, Guyana 
 

Dakari Jordan1, Dacia Simpson1, Rajini Kurup1*, Audrey Anderson1  
and Cecil Boston1 

 
1
Faculty of Health Science, University of Guyana, Turkeyen Campus, Georgetown, Guyana. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. Authors AA, DS and DJ oversaw study 
design, data collection and initial data analysis. Authors RK and CB participated in study design and 

final data analysis and interpretation. In addition, authors RK and CB revised the manuscript and 
approved final version. 

 

Article Information 

 
Editor(s): 

(1) Dr. Darko Nozic, University of Belgrade, Serbia. 

Reviewers: 

(1) Mra Aye, Melaka Manipal Medical College, Malaysia. 

 (2) Ng Hak Yung, Tseung Kwan O Hospital, China. 

Complete Peer review History: http://www.sdiarticle4.com/review-history/55501 

 

 

 

 
Received 09 January 2020 

Accepted 15 March 2020 
Published 25 March 2020 

 
 
ABSTRACT 
 

Objective: The purpose of this study was to examine the incidence of pre-diabetes and associated 
central obesity among sampled University of Guyana students. 
Methods: The study was a cross sectional study where a questionnaire was distributed to each 
participant to assess predisposing risk factors. Anthropometric measurements like BMI and HbA1c 
were used to ascertain if the participant was overweight or obese. Nycocard® HbA1c test kit was 
used for collecting HbA1c. Data was analyzed using SPSS 20.0 to calculate descriptive statistics 
and analysis of variance were used to investigate the research questions. A p value of <0.05 was 
considered to be significant for all analysis.  
Results: A total of seventy-four students were randomly selected for the study. The findings of this 
study revealed pre-diabetes incidence of 40.5% and a weak positive correlation between central 
obesity and pre-diabetes, with r-values of 0.25 (males), 0.27 (females) & 0.26 (overall).  

Original Research Article 



 
 
 
 

Jordan et al.; AJI, 3(1): 39-45, 2020; Article no.AJI.55501 
 
 

 
40 

 

Conclusion: There was a weak association between central obesity and pre-diabetes incidence. 
Therefore, a large follow up study would be important to understand association between           
pre-diabetes and central obesity and to create nationwide awareness or development of an 
operational policy/strategy/action plan to reduce overweight. 

 
 
Keywords: Incidence; pre-diabetes; central obesity; type 2 diabetes. 
 
1. INTRODUCTION 
 
The epidemic of type 2 diabetes continues to 
pose a challenge to both developed and 
developing countries, accounting for 95% of all 
diabetes cases [1]. The morbidity, mortality and 
the cost of care associated with type 2 diabetes 
makes it an important global public health 
concern. Globally, the number of people with 
diabetes is expected to almost double in the next 
two decades, increasing from 415 million in 2015 
to 642 million in 2040 [2]. Moreover, given the 
burden of type 2 diabetes and its complications, 
much attention has been given to prevention, 
beginning with identifying at risk individuals. This 
has led to the designation of the term “pre-
diabetes.” Pre-diabetes characterizes an 
individual having blood glucose levels higher 
than normal but not high enough to be classified 
as diabetes. Without weight loss measures, 
healthy eating and moderate physical activity 
many people living with pre-diabetes will go on to 
develop diabetes [3]. 

 
Approximately 5-10% of people per year with 
pre-diabetes progress to diabetes; with similar 
proportion converting back to normoglycemia [4]. 
Observational evidence suggests an association 
between pre-diabetes and several adverse 
health outcomes, which includes: early forms of 
nephropathy, small fiber neuropathy, diabetic 
retinopathy, chronic kidney disease and 
increased risk of macrovascular disease [4].   
Pre-diabetes is also associated with being 
overweight or obese and carries an excess risk 
for Cardiovascular Disease (CVD) and death. 
This is of tremendous public health concern as 
the global burden of obesity has significantly 
increased. The most recent analysis by the 
World Health Organization (WHO) reports that 
the number of adults globally who are overweight 
or obese is 1.9 billion and 650 million, 
respectively [5]. The Pan American Health 
Organization has also estimate that more than 
half the population in Latin America and the 
Caribbean is overweight, with 58% or 360 million 
people being overweight and 23% or 140 million 
people are estimated to be obese. Obesity in 

women is 10% higher than in men [6]. Due to   
this increase in the epidemic of obesity; 
understanding body fat distribution and its clinical 
implications is critical to a timely intervention. 
Adipose tissue is a special type of loose 
connective tissue in which adipose cells 
(adipocytes) predominates. Primitively, it was 
considered simply as storage organ for 
triacylglycerol, however, over the last decade 
there has been considerable experimental data 
about the biology and biochemistry of adipose 
tissue that it is no longer considered to be an 
inert tissue that just stores fat. It is a 
metabolically dynamic organ that is not only the 
primary site of storage for excess energy, but 
also serves as an endocrine organ capable of 
synthesizing a number of biologically active 
compounds that regulate metabolic homeostasis 
[7]. 
 
Diabetes continues to be a major health issue in 
Guyana; since it’s a relatively small population 
and continues to be a burden on the healthcare 
system. To date, no study was conducted to 
evaluate and assess the incidence of pre-
diabetes among the Guyanese population and 
therefore combat the rate of progression to 
diabetes. 
 
2. MATERIALS AND METHODS  
 
The study was a cross sectional study where 
University of Guyana (UG) students ≥18 years 
old, who were overweight or obese or had waist 
circumferences exceeding 80 cm (females) and 
90 cm (males) were randomly selected for the 
study. All participants were told about the study 
and an informed consent form was obtained 
before the study.  The study was conducted 
during March 2018. A total of 92 participants 
were enrolled in the study of which 74 
participants completed the study. Others were 
excluded due to various reasons like incomplete 
information, reluctance to perform tests. 
 
Inclusion criteria: Students enrolled at UG with 
an identification card, no known disease 
condition, willingness to enroll in the study. 
 



 
 
 
 

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41 

 

Instrument for weight assessment: Portable 
electronic weighing scale. 
 

Instrument for height and waist assessment: 
Constant tension tape, for waist circumference 
measurement was taken 2.5 cm above the 
umbilicus. 
 

Criteria for Prediabetes: Patients with 
prediabetes are defined by the presence of 
impaired fasting glucose (IFG) and/or impaired 
glucose tolerance (IGT) and/or A1C 5.7–6.4% 
(39–47 mmol/mol). 
 

Measurement of blood pressure: Digital blood 
pressure monitor was used. Normal blood 
pressure was considered measured if systolic 
under 140 mmHg and diastolic under 90 mmHg.  
 

A questionnaire was distributed to each 
participant to assess predisposing risk factors. 
BMI was used to ascertain if the participant was 
overweight or obese by measuring the height in 
cm and weight in kg. Nycocard® HbA1c test kit 
was used to assess the HbA1c levels of each 
participant. Data was analyzed using SPSS 
version 20.0 software for frequencies, descriptive 
statistics, and analysis of variance. A p value of 
≤0.05 was considered to be significant for all 
analysis.  
 

Ministry of Public Health, Institutional Review 
Board (IRB) gave approval for conducting the 
study, Medical Arts Laboratory and the University 
of Guyana (UG) to carry out this study. 
 

3. RESULTS  
 
Of the 92 students participated in the study, 74 
met the inclusion criteria, with 80% participation 
rate. A higher percentage of participants (67.6%) 
were females and 32.4% were males (Table 1).  
 

Table 1 shows the baseline characteristics and 
anthropometric indices of the study population. 
Mean ± SD height and weight were 167.7±1.1 
cm and 88.9±3.9 kg respectively, with the mean 
BMI being 31.4±1.1 kg/m2. The incidence of 
overweight and obesity was estimated to be 
40.5% and 44.6% respectively. The mean waist 
circumference for men and women were 101.4± 
2.3 cm and 96.4±1.6 cm, respectively.  
 

Out of a total of 74 participants, 30 (40.5%) were 
considered pre-diabetic, 6 (8.1%) were 
considered diabetic and 38 (51.3%) were 
considered non-diabetic/pre-diabetic (Table 2). A 
weak positive correlation was recorded between 
central obesity and pre-diabetes (r=0.25 for 

males, r=0.27 for females and r=0.26 for total 
participants). Among female participants, 21 
(42.0%) were pre-diabetic and 4 (8.0%) were 
diabetic. However, for males 9 (37.7%) were   
pre-diabetic and 2 (8.3%) were diabetic. Females 
accounted for the highest number of pre-diabetes 
person in the study. The mean HbA1c was 
5.8±0.1%. Correlation of HbA1c among male 
students were r=0.25 (p≥0.05), for females 
r=0.27 (≥0.05) and for total participants r=0.26 
(≤0.005). 
 
Only 16 (21.6%) participants indicated that they 
engage in high level of physical activity, 24 
(32.4%) in a low level of physical activity, while 
34 (45.9%) reported a moderate level of physical 
activity. Only three participants indicated that 
they are smokers.  Interestingly, a significant 
proportion (66.3%) of persons reported that they 
have a family history of diabetes.  Overall, 30 
(40.5%) participants were classified as having 
pre-diabetes and 6 (8.1%) as being diabetic. 
Amerindian ethnic group had higher risk of being 
pre-diabetic compared to African ethnic group 
(Odds ratio=2.9). In addition, the odd of someone 
being pre-diabetic is 2.86 for the Amerindian 
ethnicity compared to the African ethnicity.  

 
Overall there was a strong positive correlation 
(r=0.8) between family history and pre-diabetes 
and weak positive correlation (r=0.4) between 
physical activity and the development of          
pre-diabetes.  

 
4. DISCUSSION 
 
This is the first cross-sectional study that has 
examined the incidence of pre-diabetes among   
a sampled Guyanese population and its 
association with central/abdominal obesity. 
Several important findings were observed in this 
study. Firstly, incidence of pre-diabetes was 
estimated at 30 (40.5%) within the sample. 
Similarly, a study from Iran, also a country with a 
high prevalence of diabetes (11.4%) [8], showed 
that pre-diabetes had an incidence of 40.6 per 
1000-person years of those aged 20 and above 
[9]. Within this study females (28.3%) had the 
highest incidence of pre-diabetes as compared to 
males (12.1%). This was mainly due to the larger 
portion of our study population constituted by 
females, (i.e., 67.6%). Moreover, this may be a 
good representation of the large number of 
women at risk of developing future diabetes in 
Guyana, a country with a high prevalence of 
diabetes among women (10.9%) [5]. The 
incidence of central obesity was higher than 



 
 
 
 

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42 

 

overall obesity, which indicates a significant 
portion of the population, may not be classified 
as obese by BMI level. Overall the incidence of 
central obesity was found higher among the 
study participants. These finding are consistent 

with studies conducted in China and the United 
States of America [10,11]. The association of 
central obesity and the incidence of pre-diabetes 
were weakly correlated and overall were 
statistically significant.  

 

Table 1. Shows the baseline characteristics and anthropometric indices 
 

Variable    % (n) 

Sex:  
Female 67.6 (50) 
Male 32.4 (24) 
Faculty:  
FHS 16.2 (12) 
FNS 16.2 (12) 
FSS 10.8 (8) 
FEES 13.5 (10) 
FOA 13.5(10) 
FOT 16.2 (12) 
FEH 13.5 (10) 
Ethnicity:  
African 51.4 (38) 
East Indian 18.9 (14) 
Amerindian 4.1    (3) 
Mixed 25.7  (19) 
BMI Group:  
Underweight ( <18.5) 0.0    (0) 
Normal (18.5 - 24.9) 16.2 (12) 
Overweight (25 - 29.9) 40.5 (29) 
Obese (≥30) 44.6 (33) 
Mean Waist Circumference:  
Female 96.4 cm 
Male 101.4 cm 
Mean Weight 88.9 kg 
Mean height 167.7 cm 
Mean HbA1c Values:  
Female 5.7 % 
Male 5.2 % 
Pre-diabetic:  
Yes 40.5 (30) 
No 59.5 (44) 
Family History:  
Yes 68.9 (51) 
No 31.1 (23) 
Physically Active:  
Low 32.4 (24) 
Moderate 45.9 (34) 
High 21.6 (16) 
Smoking status:  
Yes   4.0  (3) 
No 95.9 (71) 
Hypertension:  
Yes 2.7   (2) 
No 97.3  (72) 



 
 
 
 

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Variable    % (n) 

Symptoms of  
Increase Thirst  
Yes 31.1 (23) 
No 68.9 (51) 
Dry Mouth  
Yes 20.3 (15) 
No 79.7 (59) 
Itchy Skin  
Yes 27.0 (20) 
No 73.0 (54) 
Blurred Vision  
Yes 32.4 (24) 
No 17.6 (50) 
Loss of Appetite  
Yes 23.0 (17) 
No 77.0 (57) 
Frequent Urination  
Yes 33.8 (25) 
No 66.2 (49) 

FHS-Faculty of Health Sciences, FNS-Faculty of Natural Sciences, FSS-Faculty of Social Sciences,  
FOA-Faculty of Agriculture, FOT-Faculty of Technology, FEH-Faculty of Education & Humanities 

 
Table 2. BMI and diabetes status among participants 

 

BMI status n (%) 95% CI p-value 

Normal 12 (16.2) 8.7-26.6  

Overweight 29 (39.2) 28.0-51.2  

Obese 33 (44.6) 33.2-56.6 ≤0.05 

Diabetes status    

Normal 38 (51.4) 39.4-63.1  

Pre Diabetes 30 (40.5) 29.3-52.6  

Diabetes 6 (8.1) 3.0-16.8 ≤0.001 

 
Previous studies have assessed the relationship 
between obesity and pre-diabetes incidence  
[11]. In most of these studies reported to date, 
obesity was measured using body mass index 
(BMI) as it has shown many advantages as a 
surrogate of body fat, such as simplicity and 
reproducibility. However, a significant limitation of 
using BMI is its inability to differentiate between 
lean mass and fat mass, especially in patients 
with a BMI <30 kg/m2 across age, sex and             
race [12]. Secondly, fat distribution could not              
be distinguished by BMI, whilst it has been 
generally accepted that visceral adiposity plays a 
more important role in developing insulin 
resistance and diabetes rather than overall 
adiposity.  When comparing Asians and 
Europeans with similar BMIs, subjects with BMIs 
less than 25 kg/m2 need to be considered as 
high-risk for type 2 diabetes or heart diseases 
[13].  

Waist circumference (WC) is considered a good 
anthropometric indicator for abdominal obesity 
because it is an aggregate measurement of the 
actual amount of total and abdominal fat 
accumulation. It has long been assumed that 
diabetes is associated with abdominal obesity 
and anthropometric measurements such as waist  
circumference that correlate with regional body 
fat distribution more so than BMI.  Correlations of 
intra-abdominal visceral fat with waist 
circumference is thought to be the biological 
explanation for the superiority of waist 
circumference as a predictor of diabetes 
compared to BMI. Coelho et al. [14] reported that 
accumulation of visceral fat stores affects insulin 
metabolism by releasing a number of bioactive 
substances such as free fatty acids which when 
elevated, induce hepatic insulin resistance, 
particularly by enhancing gluconeogenesis. This 
was further supported by the fact that 



 
 
 
 

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44 

 

gluconeogenesis increases in proportion to 
visceral fat [15]. Other studies have also 
suggested that the waist-to-height ratio is the 
best measure of obesity, compared to other 
anthropometric measures [16]. 
 
Females accounted for the highest number of 
pre-diabetes person in the study, which can be 
tied to the fact that the larger portion of the study 
population constituted females. Moreover, this 
may be a good representation of the large 
number of women at risk of developing future 
diabetes in Guyana, a country with an increasing 
prevalence of diabetes among women [5]. This 
study showed a high incidence of pre-diabetes 
(40.5%), which is a worrisome especially due to 
the fact that participants are young adults from 
the university. International Diabetes Federation 
(IDF) estimates 587 million individuals with pre 
diabetes by 2045 [9]. 
 
In addition, the odd of someone being pre-
diabetic is 2.86 for the Amerindian ethnicity 
compared to the African ethnicity. This implies 
that a pre-diabetic person is 2.86 times more 
likely to be from the Amerindian descendant 
compared to the African descendant from the 
study population. 
 
This study has several limitations that should be 
considered. The major limitation was the cross-
sectional design, which describes the exposure 
and outcomes at a time. Therefore, our data had 
shown only the associations with present risk 
factors but did not predict the future risk of 
prediabetes. Longitudinal follow-up studies are 
needed to further examine the relationship found 
in our study. Secondly the small sample size and 
the few numbers of cases with prediabetes that 
decrease the statistical power of the analysis. 
Furthermore, our study population was not a 
representative of the general population.  Lastly, 
caution should be taken in interpreting our results 
as even though the use of Waist Circumference 
(WC) provided a simple measurement for 
Visceral fat (VF), it does not represent only VF, 
as subcutaneous fat (SCF) also contributes to it. 
Computerized Tomography (CT) is the gold 
standard for the measurement of visceral fat 
volume, however, it is expensive and involves 
radiation which does not justify its use as a 
screening tool. Nevertheless, this study has 
several strengths including sizable response rate 
(80%), followed by simple random procedure for 
sample collection and using anthropometric 
variables, not self-reported values, in a sample of 
university students with very reliable data. 

Furthermore, confounding effects of various 
confounders and mediators were considered in 
data analyses.  
 

5. CONCLUSION 
 
Although the magnitude of pre-diabetes can 
differ across nations and by personal 
characteristics, there is an international 
consensus that the health complications 
associated with pre-diabetes in young adults are 
alarming and therefore strategies aimed at 
preventing abdominal obesity are urgently 
needed to reduce the increasing burden of 
diabetes, CVD, and metabolic diseases. 
 
We the researchers recommend the following: 
 
 Conduct follow-up studies with a larger 

sample size. 
 Prioritization of pre-diabetes care and 

prevention such as hosting nationwide 
awareness sessions. 

 Development of an operational policy/ 
strategy/action plan to reduce overweight 
and obesity.  

 Extend health promotion to reduce pre-
diabetes and its complications.  

 
CONSENT 
 
All authors declare that ‘written informed consent 
was obtained from the patient.  

 
ETHICAL APPROVAL 
 
Approval was granted from IRB, Ministry of 
Public Health, Guyana. 
 

ACKNOWLEDGEMENT 
 
Authors are thankful to staffs and management 
of Medical Art’s Laboratory. Heartfelt thanks are 
also extended to the law firm of Hughes, Fields 
and Stoby. 
 
COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

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(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, 
provided the original work is properly cited. 
 
 

 
 

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