Comparison of Prevalence of Pre-Diabetes and Type-2 Diabetes Mellitus Between Athletes and Non-Athletes

By Muhammad Irfan¹, Fatima Abid², Sassi Kanwal ³, Aliya Jafri², Padma Rathore², Noor Un-Nisa Memon²

Doi: https://doi.org/10.36283/ziun-pjmd14-1/008

How to cite: Irfan M, Abid F, Kanwal S, Jafri A, Rathore P, Memon NUN of Comparison of Prevalence of Pre-Diabetes and Type-2 Diabetes Mellitus Between Athletes and Non-Athletes. Pak J Med Dent. 2025 Jan ;14(1): 47-52. Doi: https://doi.org/10.36283/ziun-pjmd14-1/008.

Received: Wed, July 31, 2024 Accepted: Sat, November 30, 2024 Published: Fri, January 10, 2025

Background: Sports and Exercise activities are exceedingly advantageous for the human body and extremely helpful in decreasing the risks of diseases. The purpose of this research was to know the prevalence of pre-diabetes and Type 2 diabetes mellitus among athletes and non-athletes.

Methods: This analytical cross-sectional research was conducted between April 2021 and November 2021 at the Department of Physiology, Bolan Medical College, Quetta. The 670 male participants were interviewed randomly primarily on demographics and complete medical history with 350 athletes and 320 non-athletes from the general population of the same approved and recruited athletes. HbA1c was used to define prediabetes and type 2 diabetes using the American Diabetes Association criteria for various signs and symptoms. The data analysis was conducted using SPSS version 21. The independent t-test was used to compare both groups and correlation analysis was used to determine the relationship (r) between HbA1c levels and BMI. A p-value <0.05 indicated statistical significance.

Results: In athletes, the prevalence of pre-diabetes was 11 (3.1%) and Type-2 diabetes mellitus (T2DM) was 21 (6%) compared to non-athlete control participants having pre-diabetes was 73 (22.8%) and T2DM was 61 (19.0%) (p=0.001).

Conclusions: Regular exercise decreases the prevalence of pre-diabetes and T2DM among the athletes compared to non-athlete participants. The results of the study indicated that there is a necessity to increase awareness of the importance of physical activity, support, and urge people to engage in physical activity and fight this rapidly increasing ‘diabetes epidemic’.

Keywords: Cricket, Sport, Prevalence, Diabetes Mellitus, Athletes

Diabetes mellitus is a well-known and major problem globally, which is associated with high mortality and has a great impact on the economy as well as on medical services ¹. Despite astounding improvements in clinical sciences, it is as of yet a hopeless long-lasting disease ². The current worldwide pervasiveness of diabetes mellitus is 463 million; with 374 million individuals experiencing glucose resistance though 232 million individuals know nothing about the way that they are experiencing the sickness. In 2019, Diabetes claimed the lives of 4.2 million individuals, globally along with an astounding USD 760 billion expenditure on the disease³. With this high mortality rate and even higher expenditure, health systems are suffering due to the negative impact⁴. Globally, many states with healthcare associations have created different approaches to improve ongoing risk factors, like lifestyle improvement which include quitting smoking, a healthy diet consisting of less refined food consumption, and more fiber, protein, and healthy carbs to diminish the incidence of incapacitating illnesses ^5-6. Inadequate physical activity an overly refined diet, and a static lifestyle are also one of the main causes of the prevalence of diabetes mellitus. Physical exercise and games associated with proactive work have a very long-term effect on the successful management of DM. Sports further develop perseverance limits and improve cardiovascular and metabolic health ⁷. Special physical-based mediations in stationary individuals can also accomplish essential preventive impacts and expansive upgrades in health ⁸. Recent research has shown that it works on oxygen-consuming wellness, strong execution, metabolic and cardiovascular capability, and reduces obesity ⁹.  However, literature is incredibly missing to lay out a relationship between playing cricket and the predominance of Type-2 diabetes mellitus (T2DM). This study aimed to examine the occurrence of pre-diabetes and Type 2 Diabetes Mellitus (T2DM) among cricket players and compare these findings with those from a control group of non-athletes from the general population.

This cross-sectional study was conducted at the Department of Physiology, Bolan Medical College, Quetta from April 2021 to November 2021 after getting approval No.IRB-1/ESTB/2023/BMC/117-04. Data collection involved visits to research facilities, parks, universities, sports complexes, and sports grounds to gather information on participant activities. In this study, 670 male subjects were interviewed of which 350 athletes and 320 non-athletes were willing to be part of the study. After obtaining demographic data as well as detailed medical histories, 350 athletes and 320 non-athletes were selected as the study and control groups respectively.

Athletes were defined as individuals engaged in regular physical exercise for approximately 150 minutes per week, performed on non-consecutive days, by the American Diabetes Association criteria. To reduce the possibility of confounding variables the involved subject’s exposure to toxic materials in such industries as activities coal, cement, or flour factories was omitted as such exposure can enhance the risk of diabetes mellitus. Non-athletes were people who engaged in no sports or physical activities at all.

Those who had a history of blood disorders such as anemia, respiratory diseases such as asthma or COPD, cardiomyopathies, hypertension, diabetes mellitus, malignancies, or liver diseases were excluded from the study. Also, those who used cigarettes or shisha or worked in a factory were not enrolled in the study^10,11,12. The two groups were matched by age, height, and food habits. Regular exercise for athletes and the absence of physical activity among non-athletes were confirmed through a detailed questionnaire. All individuals provided written informed permission before enrolment.

Glycated hemoglobin (HbA1c) levels estimated were standardized according to the international federation. of diabetes mellitus. Internationally classified into three categories depending on their HbA1c < result; 5. those 6% were considered non-diabetic, those with HbA1c 5. 6%–6. 5% were considered pre-diabetic while those with HbA1c > 6. 5% were considered diabetic.

The data analysis was conducted using SPSS version 21. The anthropometric variables, which are continuous such as age, weight, height, and BMI, were expressed as mean ± SD. The independent t-test was used to compare both groups and regression analysis was used to determine the relationship (r) between HbA1c levels. A p-value <0.05 indicated statistical significance.

A total of 670 participants were enrolled in the current study out of which 350 (52.3%) were athletes while 320 (47.7%) were non-athletes as control. The two groups were matched for age, weight, and height as stated in Table -1.

Table 1: Anthropometric Measurements and HbA1c: Comparison of Non-Diabetes, Pre-Diabetes, and T2DM between Athletes and Non-Athletes:

Importantly, no significant mean difference was seen in age, weight, and height between the two groups (p>0.05) (Table 1). The Athlete group showed a significantly reduced mean difference in BMI as compared with non-athletes (p<0.001*).

Table 2: Comparison of Prevalence of Non-Diabetes, Pre-Diabetes, and T2DM between Athletes and Non-Athletes:

Table 2 Nevertheless shows, a comparison of disease amongst the athlete group and non-athlete group, the frequency of pre-diabetes was 11 (3.1%) which is significantly lower than in the non-athlete control group 73(22.8%) with p<0.001*. Equally, the frequency of T2DM of athletes was 21(6%) which is also significantly lower as compared to T2DM of non-athletes groups 61(19.0%) with p<0.001*. Furthermore, the percentage of non-diabetic participants was also found to be significantly lower in athletes’ group 318 (90.8%) as compared with non-athletes control 186 (58.1%) with p<0.001*.

Table 3: HbA1c with BMI: Comparison Between Groups

Table 3 shows the comparison between BMI and HbA1c between the athlete and non-athlete groups.

Table 4: Spearman’s Correlation Between BMI and HbA1c

Table 4 shows the correlation coefficient between BMI and HbA1c of both study groups is 0.938, which is a very strong positive correlation. This suggests that as BMI increases, HbA1c tends to increase significantly. The p-value (Sig. 2-tailed) is 0.000, showing a statistically significant association (p < 0.01 in all the relevant tables and figures.

The current study has the intention to find out the pervasiveness of pre-diabetes and T2DM amongst athletes and non-athletes present in the general population. In this study, it was found that the pervasiveness of T2DM in athletes was 21% as compared to the non-athletes control group, which was 61%. This concludes that there is a 3-fold decrease in T2DM in athletes as compared to non-athletes with similar age, height, and dietary habits. This finding also endorses this perception that the T2DM pervasiveness was significantly lower in athletes as compared to general population non-athletes, where T2DM is escalating too rapidly universally ¹³. Exercise and sports activities done by athletes have a great impact on body glucose metabolism ¹⁴.  It was revealed that approximately 6 weeks of regular exercise by T2DM patients has shown significant betterment in their β-cell function, lowering total body fat and upgrading organ functions ¹⁵. In another important study, they have published that 6-week exercise increases the sensitivity of insulin in body cells ¹⁶. It is further endorsed that sports-associated activities augment the sensitivity of insulin, have a strong role in lowering body glucose, and prominently prevent and slow down T2DM complications ¹⁷. authors appraised the relation of physical activity with T2DM prevalence and proved that physical activity reduces the risk and prevalence of diabetes ¹⁸. Another study also accounted for the value of sports activities on the cardiovascular system, body function, and bone health, as it provides an environment for reducing glucose from the body, increases the sensitivity of β-cell to insulin, and reduces the risk of diabetes mellitus ¹⁹. Some other researchers have accomplished that habitual exercise and sports activities are the utmost significant tools for the deterrence and management of essential hypertension and diabetes mellitus ²⁰. Another research displayed that athletes have a lower prevalence of pre-diabetes and T2DM as compared to the general population ²¹. The current study results have also shown a significantly lower pervasiveness of pre-diabetes and T2DM amongst athletes compared to non-athletes. Physical activity not only decreases the risk of DM but also, ironically, sports activities and exercise reduce oxidative stress, enhancing total oxidant status thereby increasing the transport of glucose into the muscles in the body ²². Another important publication has revealed that acute sports exercise can decrease the body’s glucose levels and increase antioxidant activity by 2-fold ^23-24. One of the published studies discovered a correlation between BMI and HbA1c levels ²⁵.  Similar to our findings, another study also discovered an association between BMI and HbA1c levels in athletes and non-athletes²⁶.

This clinical research suggests a potential association of BMI and HbA1c between athletes and non-athletes with no clear linear correlation. There is a general trend indicating that individuals with higher HbA1c values tend to have higher BMIs. This finding highlights the importance of maintaining a healthy weight and managing blood sugar levels to reduce the risk of diabetes²⁷.

This study confirms strong positive correlation between BMI and HbA1c suggests that as BMI increases, HbA1c levels also tend to rise.  Like our result, Hovestadt et al. found a significant positive correlation between BMI and HbA1c in their research of German children and adolescents²⁸. Other study examined the relationship between physical activity and the risk of diabetes in athletes^29. Potential confounding variables like socioeconomic status, a family history of diabetes, and other medical disorders should be properly controlled in future research.

Exercise and sports-allied activities have a considerably important role in decreasing pre-diabetes and T2DM incidence in the general population. Regular physical exercise not only reduces the risk of diabetes mellitus but also declines the prevalence of diabetes and other diabetes-related diseases in society. Health officials ought to lay out additional games and sports activities for people in general to give better results which will help in limiting the frequency of pre-diabetes and T2DM. Encouraging people and facilitating them to perform physical activities can drastically reduce the prevalence of T2DM.

 We thank the Head of the Physiology Department at Bolan Medical College, Quetta.

The authors have declared that no competing interests exist.

The ethical approval for the current study was taken from the Institutional Review Board of Bolan Medical College No.IRB-1/ESTB/2023/BMC/117-04

None.

The authors contributed equally to the development of the manuscript.

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