Prevalence of Prediabetic Adolescents and Adults in the United States

by | Dec 30, 2019 | 2019, Cardiovascular Health, Diabetes

Written by Joyce Smith, BS. Analyses of data reveals that adolescents and young adults with prediabetes are at increased risk of developing type 2 diabetes and cardiovascular diseases.

diabetesThe incidence and prevalence of type 2 diabetes in US adolescents has increased 1,2 significantly and is predicted to increase more than 4-fold 3 within the next few decades. The criteria for prediabetes is defined as follows:

  • impaired fasting plasma glucose (IFG) of 100 to 126 mg/dL,
  • impaired glucose tolerance (IGT) with a 2-hour plasma glucose of 140 to 200 mg/dL, and
  • elevated glycated hemoglobin (HbA1c) level of 5.7% to 6.4% 4.

In adults, these 3 phenotypes increase the risk of developing type 2 diabetes 5 as well as cardiovascular diseases 6. Thus it is prudent to identify and monitor at risk adolescents and young adults to develop and implement prevention strategies.

With that goal in mind, researchers did a cross-sectional analysis 7 of 5786 individuals from the 2005-2016 National Health and Nutrition Examination Survey to assess a population-based sample of 45% adolescents and 55% young adults who met the above criteria. The study’s objective, using the established  criteria for prediabetes  as mentioned above, was to determine the prevalence of IFG, IGT, and HbA1c levels in US adolescents (n=2606), aged 12-18 years, and young adults (n=3180), aged 19-34 years, who were nonpregnant and diabetic free.

The research team found that most of the individuals identified as having prediabetes in the analysis met the criteria for impaired fasting glucose: 11.1% (95% CI 9.5%-13.0%) of adolescents and 15.8% (95% CI 14.0%-17.9%) of young adults. In a predictive model, 22.5% of male adolescents had nearly double the prevalence of prediabetes compared to 13.4% of females. A similar trend was seen among young adults, where 29.1% of men had a significantly higher prevalence of prediabetes compared to 18.8% of women (18.8%, 95% CI 16.5%-21.3%). These predictive models were also adjusted for age, sex, race, and body mass index (BMI).

There was also a higher prediabetic prevalence among obese individuals compared to those of normal weight. Specifically, 36.9 % of obese young adults were prediabetic compared with only 18.8% of normal weight adults. A similar trend was seen in obese adolescents where 25.7% met the criteria for prediabetes compared to only 16.4% of adolescents of normal weight.

Prediabetic people also tended to have several increased metabolic risk factors. Compared to adolescents who were diabetic free, those who were prediabetic had significantly higher systolic blood pressure (112.6 vs 108.5 mm HG); non-high density lipoprotein cholesterol (109.3 vs 101.6 mg/dL); waist to height ratio (0.51 vs 0.49); BMI (25.1 vs 23.5); fasting insulin (5.0 vs 4.4 uU/mL); and  insulin sensitivity (7.9 vs 8.6 single point insulin sensitivity estimator). Prediabetic young adults had a significantly worse cardiometabolic profile: SBP (117 vs 113.4 mm Hg; cholesterol (132.8 vs 101.6 mg/dL); waist to height ratio (0.59 vs 0.53); BMI (30.8 vs 26.7); Fasting insulin (5.1 vs 4.0 uU/mL); Insulin sensitivity (5.6 vs 6.9).

In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Andes, Linda J., Yiling J. Cheng, Deborah B. Rolka, Edward W. Gregg, and Giuseppina Imperatore. “Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016.” JAMA pediatrics (2019): e194498-e194498.

© 2019 American Medical Association. All rights reserved.

Posted December 30, 2019.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. New England Journal of Medicine. 2017;376(15):1419-1429.
  2. Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. Jama. 2017;317(8):825-835.
  3. Imperatore G, Boyle JP, Thompson TJ, et al. Projections of type 1 and type 2 diabetes burden in the US population aged< 20 years through 2050: dynamic modeling of incidence, mortality, and population growth. Diabetes care. 2012;35(12):2515-2520.
  4. American Diabetes Association. 5. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S51.
  5. Morris DH, Khunti K, Achana F, et al. Progression rates from HbA 1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Springer; 2013.
  6. Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. Bmj. 2016;355:i5953.
  7. Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. JAMA pediatrics. 2019:e194498-e194498.