Prediabetes Rates Climbing Among US Youth

By Linda Carroll

March 30, 2022

NEW YORK (Reuters Health) - The prevalence of prediabetes more than doubled over two decades among youths in the United States, a new study suggests.

An analysis of data from more than 6,500 children aged 12 to 19 found that rates of prediabetes jumped from nearly 12% to more than 28% between 1999 and 2018, researchers report in JAMA Pediatrics.

"The prevalence of prediabetes among U.S. youth significantly increased - more than doubled - over the past 20 years without exceptions in any subgroups," said senior author Dr. Junxiu Liu of the Icahn School of Medicine at Mount Sinai in New York City.

The study wasn't designed to explain why this is happening, she told Reuters Health by email. "However, we do see the high correlation between prediabetes and BMI because, for example, youths who are obese have a higher prevalence of prediabetes."

"I think future studies need to investigate factors contributing to rising prevalence of prediabetes among youth," Dr. Liu said. "Among the identified contributing factors, researchers could design targeted intervention strategies to reduce that. In addition, I would suggest emphasizing the role of healthy lifestyle including strategies such as healthy eating - reduce the amount of ultra-processed food intake and increase whole-food intake - regular physical activity, etc."

Dr. Liu and her colleagues turned to data from 10 two-year cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 through 2017-2018 and combined every two consecutive cycles to obtain sufficient sample sizes.

NHANES collects sociodemographic and health variables such as gender, age, race and ethnicity, parental educational level, income level, household food-security status and BMI category. The survey also obtains blood samples from each participant, from which fasting glucose and hemoglobin A1c levels were derived.

Dr. Liu and her colleagues focused on young people aged 12 to 19 who had completed the NHANES interview and examination. They defined prediabetes as no recorded diabetes diagnosis but a hemoglobin A1c level of 5.7% to 6.4% or a fasting plasma glucose level of 100 mg/dL to 125mg/dL.

The researchers' analysis was based on data from nearly 6,600 young people (mean age, 15.5), of whom just over half were male. Overall, the prevalence of prediabetes rose from 11.6% in 1999-2002 to 28.2% in 2015-2018 (P<0.001), with increases seen across all groups.

The increase was most pronounced in males, rising from 15.8% to 36.4%, as compared with females for whom rates rose from 7.1% to 19.6%.

Among those who were underweight or normal weight, the prevalence increased from 9.4% to 24.3%, while it climbed from 15.3% to 27.5% among those who were overweight, and from 18.2% to 40.4% among youth who were obese.

The researchers note limitations of the study, including only one measurement of blood biomarkers for prediabetes and the lack of an oral glucose-tolerance test.

"This should be a call to action," said Dr. Risa Wolf, a pediatric endocrinologist at Johns Hopkins Children's in Baltimore, Maryland, who was not involved in the study. "It's something we need to be aware of and think about in practice and in research and have a large scale study on how to prevent this."

"It's also important for parents and pediatricians to recognize that it's better to identify prediabetes early, before it progresses to type-2 diabetes," she told Reuters Health by phone. "It might mean counseling on nutrition and exercise."

While it may seem odd that normal and underweight kids also saw an increase in prediabetes, this may be related to type-1 diabetes developing or to puberty, Dr. Wolf said. During puberty, "we often see a physiologic increase in insulin resistance," she added. "This could be transient and will often normalize in normal and underweight patients after puberty."

SOURCE: JAMA Pediatrics, online March 28, 2022.