Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020.
Level 4 - case-series / case-control
Serial cross-sectional analysis of national survey data
PubMed 37981123 · doi:10.1016/j.diabres.2023.111022
What was done
Authors analyzed serial cross-sectional data from 6,936 US adolescents aged 12 to 19 years in the National Health and Nutrition Examination Surveys (NHANES) from 1999 through 2020. Diagnosed diabetes was established by self-reported physician diagnosis, while undiagnosed diabetes and prediabetes were identified using fasting plasma glucose and HbA1c thresholds. Logistic regression was used to evaluate risk factor associations across survey cycles.
What was found
Prediabetes prevalence increased from 11.5% in 1999–2002 to 36.3% in 2015–2020. Overall diabetes prevalence shifted from 0.82% (0.62% diagnosed, 0.20% undiagnosed) in 1999–2002 to 1.14% (0.76% diagnosed, 0.38% undiagnosed) in 2015–2020, which was not statistically significant (P = 0.69). Obesity was significantly associated with higher odds of both diabetes and prediabetes. Prediabetes risk was also significantly higher in boys and Mexican American adolescents.
Why it matters
This study demonstrates a more than threefold increase in adolescent prediabetes over two decades in the US, highlighting a substantial expansion of cardiometabolic risk in youth that is heavily concentrated among obese individuals.
Limits
The cross-sectional design cannot establish causality or determine individual progression from prediabetes to diabetes. Reliance on single-visit laboratory measurements in NHANES may introduce misclassification, and specific numerical effect sizes (such as odds ratios) for risk factors were not reported in the abstract.
Cited by
- supports One in four teenagers in the United States has prediabetes or type 2 diabetes.