Linda J. Andes
Jane L. Lynch
In the United States, roughly one in five adolescents and one in four young adults have prediabetes, according to a study published in JAMA Pediatrics.
“These findings are alarming and should be a call to action for health care providers and parents in the U.S.,” Linda J. Andes, PhD, mathematical statistician at the CDC’s Division of Diabetes Translation, told Infectious Diseases in Children. “While we expected to find prediabetes in adolescents, we were surprised to learn how common this condition has become, especially in adolescents and young adults with obesity.”
A cross-sectional analysis of data on 2,606 adolescents aged 12 to 18 years and 3,180 young adults aged 19 to 34 years from the 2005 to 2016 National Health and Nutrition Examination survey revealed prediabetes prevalence rates of 18% (95% CI, 16%-20.1%) in adolescents and 24% (95% CI, 22%-26.1%) among young adults. Impaired fasting glucose accounted for the largest proportion of prediabetes, with a prevalence of 11.1% (95% CI, 9.5%-13%) in adolescents and 15.8% (95% CI, 14%-17.9%) in young adults.
Andes and colleagues defined impaired fasting glucose as a fasting plasma glucose level of 100 mg/dL to less than 126 mg/dL, increased HbA1c level as HbA1c between 5.7% and 6.4% and impaired glucose tolerance as 2-hour plasma glucose of 140 mg/dL to less than 200 mg/dL. Obesity was defined as age- and sex-specific BMI in the 95th or higher percentile in adolescents and 30th or higher in young adults.
“Obesity has become more prevalent among U.S. adolescents and young adults,” Jane L. Lynch, MD, professor of pediatrics and interim chief of the division on endocrinology at the University of Texas, San Antonio Health, told Infectious Diseases in Children. “Due to reproducibility limitations, these data are only a rough estimate of the risk for youth in the U.S.”
Previous research has also shown a rise in diabetes in other areas of the world, such as the United Kingdom.
In the new study, multivariable logistic models accounting for sex, age, race and ethnicity and BMI showed the predictive marginal prevalence of prediabetes was significantly higher in male than female individuals in adolescents (22.5% [95% CI, 19.5%-25.4%] vs. 13.4% [95% CI, 10.8%-16.5%]) and young adults (29.1% [95% CI, 26.4%-32.1%] vs. 18.8% [95% CI, 16.5%-21.3%]).
“Early prevention efforts are critical to address the need for healthy diets from birth, family support for healthy lifestyles at home and school and safe environments for exercise,” Lynch said.
Individuals with obesity also showed significantly higher prediabetes prevalence than normal-weight individuals in both adolescence (25.7% [95% CI, 20%-32.4%] vs. 16.4% [95% CI, 14.3%-18.7%]) and young adulthood (36.9% [95% CI, 32.9%-41.1%] vs. 16.6% [95% CI, 14.2%-19.4%]). To promote healthy weight and prevent diabetes related to obesity, the CDC provided the following recommendations for state and local organizations in a news release:
- Work with early care and education centers and schools to advocate healthy food offerings and physical activity for children;
- Increase access to affordable and healthy foods;
- Make it easier and safer to bike and walk where families live; and
- Support mothers who breastfeed.
“In order to reduce the impact of prediabetes in youth, clinicians can help by measuring children’s weight and body mass index routinely, assessing their risk for prediabetes and testing the child for prediabetes if appropriate,” Andes said. “Providers should also refer families into nutrition education or childhood and youth healthy weight programs as needed.” – by Eamon Dreisbach
Disclosure: Lynch reports being a primary investigator for the NIH TODAY study, working previously as a primary investigator for the Novo Nordisk Ellipse study and being on the Novo Nordisk Global Pediatric Diabetes Expert Panel. Andes reports no relevant financial disclosures.