Prediabetes Seen in 20% of Adolescents, 25% of Young Adults

A quarter of young adults under age 35 have developed prediabetes, putting them at risk for developing type 2 diabetes (T2D) and cardiovascular disease. The trend starts in adolescence, as nearly 1 in 5 youth, aged 12 to 18, already has prediabetes, according to data published Monday in JAMA Pediatrics.

Researchers from The Centers for Disease Control and Prevention (CDC) analyzed results from the 2005-2016 National Health and Nutrition Examination Survey, and they found that the prevalence of prediabetes was higher in males and those with obesity. The authors analyzed data from 5786 individuals, including 2606 who were adolescents and 3180 who were young adults. Prevalence of prediabetes was 18.0% (95% CI, 16.0%-21.1%) among the adolescents and 24.0% (95% CI, 22.0%-26.1%) among the young adults.

The study used measures of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and rising glycated hemoglobin (A1C) to calculate estimates of prediabetes across the both the adolescent and young adult populations, noting that while all 3 measures are used to diagnose prediabetes, there are few studies on how these data points progress over time among youth to T2D. While IFG was the most common type of dysregulation found—and its link to obesity is especially important—the authors write that few primary prevention trials select participants based on this measure.

The findings highlight the public health risks of obesity and T2D, which have been tied to recent studies that find rising deaths from heart failure and even an overall drop in US life expectancy, with the long-term rise in obesity playing a role in the decline.

“Obesity is a strong predictor of increased risk for [T2D] in adults, and probably also plays a major role in the development of the disease at younger ages,” the authors write. “Obesity is highly prevalent among US adolescents and young adults. The finding that a large proportion of adolescents and young adults with obesity already present glucose metabolism abnormalities is of great public health concern given the sharp increase in type 2 diabetes in adolescence.”

The authors write that adults have been able to delay T2D with lifestyle interventions such as the National Diabetes Prevention Program (DPP), but that these strategies have not been widely studied in adolescents.

Public health implications for earlier onset of obesity and T2D go beyond cardiovascular disease. Recent demographic trends show obesity-related cancers are showing up in younger patients, and this population now has more years to develop diabetes-related renal decline. Finally, a study published earlier this year found that earlier-onset T2D tended to be particularly aggressive, leading to more hospitalization and a higher likelihood of mental health diagnoses.

The authors acknowledged several limitations in the study, one of which was the potential that combining 10 years’ worth of NHANES data may mean that prevalence estimates may be lower than current levels.

Reference

Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016 [published online December 2, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.4498.