Prediabetes and Associated Factors Among Young University Students in Lubumbashi, Democratic Republic of the Congo: A Cross-Sectional Study

Abstract

Background: Prediabetes is an important early marker of dysglycaemia and an established risk state for the subsequent development of type 2 diabetes and cardiovascular disease. However, evidence on prediabetes among young adults in sub-Saharan Africa remains limited. This study aimed to estimate the prevalence of prediabetes and identify factors associated with prediabetes among university students in Lubumbashi, Democratic Republic of the Congo (DRC).
Methods: We conducted a descriptive cross-sectional study among students aged 18–34 years enrolled at the University of Lubumbashi during the 2025–2026 academic year. Participants were selected using simple random sampling. Sociodemographic, behavioural, anthropometric and clinical data were collected using a structured questionnaire and standardised measurement procedures. Fasting plasma glucose, glycated haemoglobin (HbA1c), lipid profile and serum creatinine were measured. Prediabetes was defined as an HbA1c level of 5.7–6.4%, while values ≥6.5% were considered compatible with probable diabetes. Participants with probable diabetes were excluded from analyses of factors associated with prediabetes. Associations were assessed using bivariate and multivariable logistic regression models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Among 378 students sensitised to the study, 327 participated, corresponding to a participation rate of 86.5%. Of these, 202 (61.8%; 95% CI, 56.4–66.9) were normoglycaemic, 87 (26.6%; 95% CI, 22.1–31.7) had prediabetes, and 38 (11.6%; 95% CI, 8.6–15.6) had HbA1c values compatible with probable diabetes. Thus, 38.2% of participants had dysglycaemia. Among the 289 participants included in the comparative analysis of normoglycaemia versus prediabetes, the mean age was 22.96 ± 2.89 years, and the prevalence of prediabetes was 30.1%. Most sociodemographic, anthropometric, behavioural and clinical characteristics were not significantly associated with prediabetes. Prediabetic participants had lower mean HDL-cholesterol concentrations than normoglycaemic participants (42.92 ± 11.80 vs 49.82 ± 14.77 mg/dL; p < 0.001). In multivariable analysis, HDL-cholesterol remained independently associated with prediabetes (adjusted OR, 0.97; 95% CI, 0.94–0.99; p = 0.012), corresponding to approximately 3% lower odds of prediabetes per 1 mg/dL increase in HDL-cholesterol.
Conclusion: Prediabetes was common among university students in Lubumbashi, affecting approximately one in four students overall and nearly one in three participants after exclusion of those with probable diabetes. HDL-cholesterol was the only factor independently associated with prediabetes. The high burden of dysglycaemia observed in this young population highlights the importance of early metabolic risk assessment and prevention strategies among young adults in the DRC.