Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016.
Level 4 - case-series / case-control
Cross-sectional population-based survey (NHANES)
PubMed 31790544 · doi:10.1001/jamapediatrics.2019.4498
What was done
Cross-sectional analysis of 2005–2016 National Health and Nutrition Examination Survey (NHANES) data evaluating 5,786 non-pregnant individuals without diagnosed diabetes (2,606 adolescents aged 12–18 years and 3,180 young adults aged 19–34 years). Participants underwent fasting plasma glucose (FPG), 2-hour oral glucose tolerance test (OGTT; 75-g load), and HbA1c testing. Prediabetes was defined as impaired fasting glucose (IFG: FPG 100 to <126 mg/dL), impaired glucose tolerance (IGT: 2-hour glucose 140 to <200 mg/dL), or elevated HbA1c (5.7% to 6.4%). Fasting insulin and cardiometabolic risk markers were compared across glycemic abnormality phenotypes.
What was found
Prediabetes prevalence was 18.0% (95% CI, 16.0%–20.1%) in adolescents and 24.0% (95% CI, 22.0%–26.1%) in young adults. IFG was the most common abnormality, present in 11.1% (95% CI, 9.5%–13.0%) of adolescents and 15.8% (95% CI, 14.0%–17.9%) of young adults. In multivariable models adjusted for age, sex, race/ethnicity, and BMI: - Adjusted prevalence was higher in males than females (adolescents: 22.5% [95% CI, 19.5%–25.4%] vs 13.4% [95% CI, 10.8%–16.5%]; young adults: 29.1% [95% CI, 26.4%–32.1%] vs 18.8% [95% CI, 16.5%–21.3%]). - Obesity was associated with higher prediabetes prevalence compared with normal weight (adolescents: 25.7% [95% CI, 20.0%–32.4%] vs 16.4% [95% CI, 14.3%–18.7%]; young adults: 36.9% [95% CI, 32.9%–41.1%] vs 16.6% [95% CI, 14.2%–19.4%]). - Participants with prediabetes had significantly higher non-HDL cholesterol, systolic blood pressure, central adiposity, and lower insulin sensitivity (P < .05 for all comparisons).
Why it matters
This study shows that prediabetes affects nearly 1 in 5 adolescents and 1 in 4 young adults in the United States, accompanied by early clustering of unfavorable cardiometabolic risk factors before middle age.
Limits
The cross-sectional design cannot establish causal relationships or monitor rates of progression to type 2 diabetes or cardiovascular events. Diagnostic classifications were based on single-visit laboratory measurements rather than repeat testing, which may introduce misclassification from transient glycemic variation.
Cited by
- context One in four teenagers in the United States has prediabetes or type 2 diabetes.