Fatimah Minor raises in blood glucose considerably increase

Fatimah AL Awadh, Fatimah
ALRamadhan, Manal Balise, Badriyah ALHnowah.

Collage of
Medicine, King Faisal University, Al Ahsa – Kingdome of Saudi Arabia


The simple term “blood glucose” is surprisingly complex. Minor raises in blood
glucose considerably increase the risk of diabetes mellitus development.
Obesity and overweight is a recognized risk factor for developing type 2
diabetes. One unresolved question is, if there is a relation between body mass
index (BMI) and blood glucose level (BGL) in female students of King Faisal
University (KFU). This study examined the
correlation between BMI and BGL amongst 125 randomly selected, consenting KFU
female students who are apparently healthy. There
is no significant correlation between BMI and BGL in subjects. College of
medicine student subjects had significantly lower BGL compared with college of
sciences and others. Number of sugar spoons in subjects’ hot drink with body
mass index is approaching significance with p = 0.09. High
blood glucose levels in young females don’t results from high BMI. Instead,
they are associated with high sugar consumption. Awareness should be increase
among the university students in order to reduce the prevalence of
hyperglycemia and consequent pre-diabetes.  

Index Terms— Blood glucose level,
Body mass index, Diabetes, Hyperglycemia, Obesity, Overweight, Prediabetes.

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1   Introduction                                                                     

Diabetes is a chronic illness that
needs endless health care and constant self-management, public health
education and reliable psychosocial support to avoid acute complications and
to shrink the risk of chronic complications (1). The highest prevalence of
diabetes overall is anticipated to occur in the Middle East and North Africa
due to rapid economic development, urbanization and changes in lifestyle
patterns in the region. (2)

The simple phrase “blood
glucose” is remarkably complex. Blood glucose can be highly variable, growing
briskly after a carbohydrate meal then falling to the relatively steady fasting
state (3). Minor raises in blood glucose considerably increase the risk of
diabetes mellitus development (4). A study in England founded a significant association
between an elevated BMI and diagnosis of type-2 diabetes mellitus from a study
of about 7000 British men (12 years mean follow-up) (5). Moreover, a report by
the Saudi Arabian Ministry of Health, published that nearly 0.9?million people
were diagnosed DM in the year 1992, However this rate reached 2.5?million
people in 2010, signifying a 2.7 times rise in the incidence in less than two
decades. (20) A cross-sectional study in 2009 carried out in KSA revealed that
30% of subjects were diagnosed with diabetes mellitus and correlating with the
prevalence of body mass index of ?25 amongst diabetics which was was 85.7%
(P<.0001). (19)   Obesity and overweight is a recognized risk factor for developing type 2 diabetes, nevertheless, most obese individuals do not develop type 2 diabetes. Latest studies have recognized correlation between Body mass index and type 2 diabetes including pro-inflammatory cytokines (tumor necrosis factor and interleukin-6), insulin resistance, deranged fatty acid metabolism, and cellular processes such as mitochondrial dysfunction and endoplasmic reticulum stress (1). It is impotent to elaborate the relationship between BMI and BGL in order to estimate the incidence of hyperglycemia level that is a risk factor for developing type 2 diabetes mellitus. Identifying risk factors is an essential step for prevention and health education as well as lowering the DM health burden. To date, no article has reviewed the relationship between BMI and BGL in female students of KFU.    2          Materials And Methods This cross-sectional study was conducted at King Faisal University during April 2013. The study was approved by the ethical board of College of Medicine in King Faisal University. The target group was female students from all colleges of KFU in apparent good health.  The sample included 125 girls with confidence level 95% and confidence interval of 8.74. Measured using online sample size calculator. The age group of the sample ranged from 18 to 26. A questionnaire was designed by the research team and tested using pilot test to be modified accordingly. A group of external undeclared respondents were chosen from different colleges of KFU and interviewed individually. The interview consisted of brief introduction about the aim of this study, handling the questionnaire and finally asking respondents to read it and answer out loud while a member of the team is recording notes. Finally, the research team reviewed all respondent's questionnaires and made minor adjustments. After obtaining the informed consent from subjects, the questionnaire was distributed. The age, the height, the weight, Random BGL and the college of the subjects were recorded.  Random blood sugar was taken using glucometer and the weight and height was measured using a scale. Our exclusion criteria included invalid blood glucose test, absent weight and height information, and pregnancy. The BMI for each subject was calculated using the standard formula i.e. weight in kilograms divided by height in square meters (6). All the variables including age, college, height, weight, BMI, BGL, diet, exercise and family history of diabetes from study group were organized and analyzed statistically using SPSS computer program. Person correlation coefficient was used to find the correlation between BGL and BMI. One-way ANOVA test was used to check the statistical significance of the changes in BMI and BG with respect to college and other factors. Chi-square test was used to find relation between body mass index categories and diet.       3   Result Analysis of one hundred and ten (110) consented female KFU students' data was carried on and the achived results are presented in Tables 1, 2, 3 and Graphs 1, 2. First, BMI and BGL didn't show significate correlation in our subjects p= 0.61. However, graph 1 showed positive association. As college changes, there is a corresponding change just in BGL but BMI changes diversely. College of medicine is statistically significantly different compared with college of Sciences and Others (Business administration, Computer and information technology, Art, Community Service and Pharmacy). The p value was (p=0.04 and p=0.003) respectively. Between the college of medicine and college of education there is a relationship approaching significance with p = 0.09. The college of medicine is not statistically significantly different in body mass index compared with others, p>0.05. In all, main relationship is
significant between college and blood glucose in subjects.

As the intake of potato chips
increases in subjects, the body mass index increases. This relationship is
significant (p=1.17). Conversely, subjects with normal BMI favorite
chocolates for snacks. The most fruit favorite snack are low BMI subjects.

Number of sugar spoons in
subjects’ hot drink with body mass index is approaching significance with p=0.09.
Overall, for the 110 subjects, BMI and BGL showed no significant relationship.




BMI (Kg/Mˆ2)

BGL (mmol/L)



24.89 ± 6.27

123.75 ± 29.75



27.33 ± 6.70

120.36 ± 28.97



26.40 ± 5.06

115.13 ± 18.84



23.69 ± 5.46

107.06 ± 20.30



27.67 ± 5.84

130.65 ± 24.92

Table 1: Body Mass Index (BMI) and
Blood Glucose Level (BGL) for female subjects in different colleges. Values are
expressed as Mean ±
SD for N subjects.


BMI Category


BGL (Moll/L)



120.28 ± 25.71



120.87 ± 27.45



119.34 ± 26.57

2: Blood Glucose Levels (BGL) in different body mass index categories. Values
are expressed as Mean ±
SD for N subjects. BMI classification: 18.5-25.0: normal, 25-30.0: overweight,
>30.0: obese.



 1 ³











Table 3: Number of sugar spoons in hot beverages among different
BGL categories.


Graph 1: The correlation between BMI and BGL.

Graph 2: The correlation between BGL and college.

Graph 3: The correlation
between BMI and favorite snack.


Graph 4: The correlation between BGL and number of sugar spoons.

4   Discussion

 Present study was conducted to evaluate the
risk of diabetes and prevalence of hyperglycemia in overweight and obese female
students of KFU, based on assessment of family history of risk factors, diet,
physical exercising and blood sugar levels in comparison with BMI.


Etiology of developing
type 2 diabetes mulites has many risk fators. However, the key modifiable and
acquired risk factor in probably is obesity as found in multiple studies
(7,8,9). A study by E. Skarfors, et al.
investigated a sample of men in Sweden with a normal BGL for development of
type-2 diabetes mellitus revealed that the incidence of diabetes mellitus grew
twenty-two times in subjects with elevated BMI compared to lower BMI subjects
(8). Similarly, a prospective study exploring about 7000 men living in England
(12.8 years’ follow-up) recognized a solid significant association between high
BMI and risk of developing type 2 diabetes. These interpretations are accepted
because obesity is scientifically proven to induce insulin resistance (10,11).


Consequently, it is
expected that BMI should correlate with blood glucose levels. This is, however,
not always the case. A Scottish study has previously shown no significant
correlation between random blood sugar levels and BMI (12). As well as our study
which has shown that the correlation between BGL and BMI among female students
of KFU was not statistically significant. The explanation for these findings
could be that our sample was young in age. And age has a major role in
development of diabetes, prediabetes, and hyperglycemia. Also, it might be that
our sample size was not large enough to illustrate the correlation. Another
factor that needs to be further explored is the racial factor as was suggested
in a study involving Caucasian and African-American women (13).


Also, we found that
hyperglycemia was more prevalent among students of sciences and other colleges
as shown in graph 2. We think that is because of sedentary life style. The
university have no gym for females at that time. Their students do have a long
break in comparison to medical students. This time is usually spent in the
cafeterias which mainly offer unhealthy junk food, rich in carbohydrates and
fat. However, the lowest blood glucose levels were among medical students. We
think that is because of their busy lifestyle between long lectures, labs,
assignments, studying and researching. Also, in the university they have no
free time or long breaks between lectures so they don’t depend on the cafeteria
food. Annother possible explanation for the significant drop in BGL in medical
students compared to sicence and others is psychological stress and even
depression. According to H. Abdulghani in a recent cross sectional study
conducted in Saudi Arabia, the stress in medical students was significantly
more in females and in preclinical years (21). Also, a study by E. Eva in
Bangladesh found that 54% of medical students are suffering from psychological
stress especially due to academic load (22). Furthermore, the risk of
developing depression in medical students, with CES-D ³ 16, was 28.4 % and 39.0% in first and thrird years
respectively with a significant increase in perceived stress (23). According to
current literature, stress can induce hypophagia as well as hyperphagia at
equal rate of 40% while 20% experience no change in eating behavior (24, 25). However,
this controversial relationship is suggested to be dependant on severity of
stresso. Where minor stress results in hyperphagia and major stress results in
hypophagia (26). This finging explains the elevated BGL in students of science
and other colleges  in relation to
medical students regarding the stress level of their academic requirements.


Furthermore, dietary
habits have long been associated with the management and/or prevention of
various metabolic disorders, such as insulin resistance, obesity, type 2
diabetes (14,15). However, our study showed no significant relation between the
daily diet and snacks between meals with blood glucose levels. However, there
was a significant relation between the number of sugar spoons consumed in hot
beverages and the BGL as shown in table 3 and graph 4. High consumption of
sugar-sweetened beverages has also been associated with a greater weight gain
and with higher risk of type 2 diabetes (16). As an explanation of the
insignificant relation between the diet and BGL, we can say that it can’t be
accurate to use a questionnaire to measure dietary habits. Subjects may not
answer accurately or not understood properly. However, the statistics revealed
that there is a relation between the snack and BMI as shown in graph 3.  


Although it is
scientifically proven that physical activity reduces the risk of type 2
diabetes (17), Our study has supported this information base by revealing inversely
related association between physical activity and underlying asymptomatic
diabetes or prediabetes. Furthermore, our finding suggests that the family
history of diabetes had no relation to the random blood glucose level. Oppose
to our findings, a cross-sectional study by R.D. Morris et al.  of female members of a weight-control club,
obesity showed a positive correlation with diagnosis of type 2 diabetes
mellitus that is greater in individuals who had a family history of diabetes
rather than in those who did not (18). This can be due to our relatively small
and young sample.


A number of limitations
were recognized by the research team. First, some data was collected using a
questionnaire. Also, the time used for data collection was short. And it was
difficult to access some collages due to distance. Finally, the lack of
experience of researcher team.


5   Conclusion

Based on this research
findings, there is no significant relation between BMI and BGL in young female
students of KFU. Also, there is no significant relation between BGL or BMI and
diet, snack, exercise, or family history in our target group. This study found
the relation between number of sugar spoons in hot beverages and BGL to be
significant. People with high blood sugar but not diabetic are considered as
pre-diabetic. Pre-diabetics are likely to develop Type 2 diabetes within 10
years. The study recommends pre-diabetics to modify their lifestyle by reducing
junk food intake and sugar spoons consumption to one and a half or less per
cup. Also, we recommend that all universities provide the facilities for a
healthier lifestyle. These facilities include a gym or a playground for
students, healthier meals and snack options and health education.

6   Acknowledgment

authors wish to thank King Faisal University for the opportunity to conduct
this study. Also, we wish to thank collage of medicine for providing the
necessary tools for the study. A special thanks to dr. Abdul Sttar Khan, a
member of Family and Community Medicine Facuilty, for his help and guidance.  



1    R. Eckel, S. Kahn, E. Ferrannini, A. Goldfine, D. Nathan, M.
Schwartz, R. Smith and S. Smith, “Obesity and Type 2 Diabetes: What Can Be
Unified and What Needs to Be Individualized?”, Diabetes Care, vol. 34, no.
6, pp. 1424-1430, 2011, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114323/.

2     IDF Diabetes Atlas, 7th ed.
Brussels: International Diabetes Federation, 2015. Available at http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf.

3    K. Sikaris, “The Correlation of Hemoglobin A1c to Blood
Glucose”, Journal of Diabetes Science and Technology, vol. 3, no. 3, pp.
429-438, 2009, available at http://jdst.org/May2009/Articles/VOL-3-3-SYM4-SIKARIS.pdf.

4    R. Gambino, “Glucose: A Simple Molecule That Is Not Simple to
Quantify”, Clinical Chemistry, vol. 53, no. 12, pp. 2040-2041, 2007, available
at http://clinchem.aaccjnls.org/content/53/12/2040.long. 

5    C. Kahn, “Insulin Action, Diabetogenes, and the Cause of Type II Diabetes”,
Diabetes, vol. 43, no. 8, pp. 1066-1085, 1994, available at http://diabetes.diabetesjournals.org/content/43/8/1066.long.

6    B.G. Vittal, G.
Praveen, P. Deepak. “A Study of Body Mass Index in Healthy Individuals and Its
Relationship with Fasting Blood Sugar,” Journal of Clinical and Diagnostic
Research serial online vol. 4, pp.3421-3424, 2010, available at www.jcdr.net/article_fulltext.asp?id=990.

7    A.G. Bakari, and G.C. Onyemelukwe, “Aetiopathogenesis of Type-2
Diabetes Mellitus,” Diabetes International vol. 13, pp. 7-9, 2005.

8    E. Skarfors, K. Selinus and H. Lithell, Risk factor for developing
non-insulin dependent diabetes: a 10 year follow up of men in Uppsala,” BMJ,
vol. 303, no. 6805, pp. 755-760, 1991. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1670998/

9    I. Godland, C. Walton, V. Wynn, S. Kumar, A. Boulton and J. Hosker,
“Role of glucose and insulin resistance in the development of type 2 diabetes
mellitus,” The Lancet, vol. 340, no. 8831, pp. 1347-2348, 1992. Available at https://www.ncbi.nlm.nih.gov/pubmed/1357346

10  P. Eveleth, “physical Status: The Use and Interpretation of Anthropometry.
Report of a WHO Expert Committee,” American Journal of Human Biology, vol. 8,
no. 6, pp. 786-787, 1996. Available at http://apps.who.int/iris/bitstream/10665/37003/1/WHO_TRS_854.pdf

11  C. Kahn, “Insulin Action, Diabetogenes, and the Cause of Type II
Diabetes,” Diabetes, vol. 43, no. 8, pp. 1066-1085, 1994. Available at http://diabetes.diabetesjournals.org/content/43/8/1066.long

12   M. Janghorbani, A. Hedley, R.
Jones, “Is the association between glucose level and “all causes” cardiovascular
mortality risk dependent on Body Mass index?” Med, vol.  6, pp. 205-212, 1991.

13  H. Dowling and F. Pi-Sunnier, “Race-dependent health risks of upper body
obesity,” Diabetes, vol. 42, no. 4, pp. 537-543, 1993. Available at http://diabetes.diabetesjournals.org/content/42/4/537.long

14  N. Steyn, J. Mann, P. Bennett, N. Temple, P. Zimmer, J Tuomilehto, J.
Lindstrom and A. Louheranta, “Diet, nutrition and the prevention of type 2
diabetes,” Public Health Nutrition, vol. 7, no. 1, 2004. Available at https://www.ncbi.nlm.nih.gov/pubmed/14972058

15  R. Villegas, A. Salim, A. Flynn and I. Perry, “Prudent diet and the risk
of insulin resistance,” Nutrition, Metabolism and Cardiovascular Disease, vol.
14, no. 6, pp. 334-343, 2004. Available at https://www.ncbi.nlm.nih.gov/pubmed/15853117

16  M. Schulze, J. Manson and D. Ludwig, “Sugar-sweetened beverages, weight
gain and incidence of type 2 diabetes in young and middle aged women” ACC
Current Journal Review, vol. 13, no. 11, pp. 34-35, 2004. Available at https://jamanetwork.com/journals/jama/fullarticle/199317

17  F. Hu, M. Leitzmann, M. Stampfer, G. Colditz, W. Willett and E. Rimm,
“Physical activity and Television watching in relation to Risk for type 2
diabetes mellitus in men,” Archives of Internal Medicine, vol. 161, no. 12, p.
1542, 2001. Available at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/648479

18  R. Morris, D. Rimm, A. Hartz, R. Kalkhoff and A. Rimm, “Obesity and
Heredity in the Etiology of Non-Insulin Dependant Diabetes Mellitus in 32,662
Adult White Women,” American Journal of Epidemiology, Vol. 130, no. 1, pp.
112-121, 1989. Available at https://www.ncbi.nlm.nih.gov/pubmed/2787103

19  K. Aljabri, S. Bokhari and K. Alqurashi, “Prevelance of diabetes
mellitus in a Saudi community “Annals of Saudi Medicine, vol. 31, no. 1, p. 19,
2011. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101719/

20  MOH Team, “Kingdom of Saudi Arabia – Ministry of Health Portal
Statistics Report,” moh.gov.sa, 2015. Available at http://www.moh.gov.sa/en/Ministry/Statistics/book/Pages/default.aspx.

21  H. Abdulghani, A. AlKanhal, E. Mahmoud, G. Ponnamperuma and E. Alfaris,
“Stress and Its Effects on Medical Students: A Cross-sectional Study at a
College of Medicine in Saudi Arabia”, Journal of Health, Population and
Nutrition, vol. 29, no. 5, 2011. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225114/

22  E. Eva, M. Islam, A. Mosaddek, M. Rahman, R. Rozario, A. Iftekhar, T.
Ahmed, I. Jahan, A. Abubakar, W. Dali, M. Razzaque, R. Habib and M. Haque,
“Prevalence of stress among medical students: a comparative study between
public and private medical schools in Bangladesh”, BMC Research Notes,
vol. 8, no. 1, 2015. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520268/

23  A. Ludwig, W. Burton, J. Weingarten, F. Milan, D. Myers and B. Kligler,
“Depression and stress amongst undergraduate medical students”, BMC
Medical Education, vol. 15, no. 1, 2015. Available at https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0425-z

24  S. Torres and C. Nowson, “Relationship between stress, eating
behavior, and obesity”, Nutrition, vol. 23, no. 11-12, pp. 887-894, 2007.
Available at https://www.ncbi.nlm.nih.gov/pubmed/17869482

25  J. Block, Y. He, A. Zaslavsky, L. Ding and J. Ayanian,
“Psychosocial Stress and Change in Weight Among US Adults”, American
Journal of Epidemiology, vol. 170, no. 2, pp. 181-192, 2009. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727271/

26  T. Robbins and P. Fray, “Stress-induced eating: Fact, fiction or
misunderstanding?”, Appetite, vol. 1, no. 2, pp. 103-133, 1980. Available
at https://www.cabdirect.org/cabdirect/abstract/19811418001