“These findings are alarming and should be a call to action, not only for healthcare providers but also for parents and young adults with obesity,” says Giuseppina Imperatore, MD, PhD, a team leader in epidemiology and statistics on diabetes at the CDC. Prediabetes means that a person’s blood sugar levels are higher than normal, but not high enough for a diabetes diagnosis. According to the CDC, prediabetes can progress to type 2 diabetes, which is associated with a higher risk of heart disease and stroke. More than 84 million Americans have prediabetes, or 1 out of 3 adults, according to the CDC. Prediabetes typically doesn’t have any symptoms — 9 out of 10 people who have prediabetes don’t even know it, says Dr. Imperatore. “We were surprised to find prediabetes was so common, especially among adolescents and young adults with obesity,” says Imperatore. Low levels of physical activity, more time sitting, and high consumption of sugary drinks and processed food can contribute to obesity, which is a very strong risk factor for type 2 diabetes, notes Imperatore. Genetics also play a role. “We suspect a big part of this trend is due to obesity — about a third of adolescents in the United States are obese or overweight.” RELATED: 5 Bad Habits That May Increase Your Risk for Prediabetes
Risk for Prediabetes Higher in Young Males and Those With Obesity
Dr. Imperatore worked on an earlier study, published on April 13, 2017, in the New England Journal of Medicine, that found a significant increase in the incidence of type 2 diabetes in people younger than 20. “Because prediabetes is a condition that increases the risk of type 2 diabetes in adults, the next question we wanted to explore was how prevalent prediabetes was in adolescents as well as young adults. This is why we analyzed this data,” says Imperatore. Researchers combined data from six two-year cycles of the National Health and Nutrition Examination Surveys (NHANES), 2005–2006 through 2015–2016. NHANES is a program of studies that examines the health and nutritional status of American adults and children. There were 5,786 participants: 2,606 adolescents ages 12–18, and 3,180 young adults ages 19–34. The group was 50.6 percent male, 58.2 percent white, 14.6 percent black, and 19.6 percent Hispanic. To be included in the study, participants couldn’t have type 1 or type 2 diabetes or be pregnant. There were three tests used to determine if a person had prediabetes: impaired fasting glucose (IFG), impaired glucose tolerance, and increased glycated hemoglobin A1C levels. Obesity was defined by body mass index (BMI), which is used as an initial screening tool. BMI is used to define overweight and obesity, per the CDC. Adolescents who had a BMI in the 95 percentile or higher and young adults with a BMI of 30 or higher were considered to have obesity. Investigators found the following results:
Prediabetes was found in 18 percent of the adolescent group and 24 percent of the young adults.Males were 22.5 percent more likely to have prediabetes than females.Prediabetes was significantly higher in individuals with obesity compared with those with healthy weight: 25.7 percent versus 16.4 in adolescents and 36.9 percent versus 16.6 percent in young adults.When compared with people with normal glucose tolerance, the subjects who had prediabetes had significantly higher cholesterol, systolic blood pressure (the first number in blood pressure which measures the pressure in the blood vessels when the heart beats), and central adiposity (belly fat).
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Prediabetes in Young People Presents Unique Challenges
These results reflect what doctors are seeing in their clinics, says Andrea Mucci, MD, a pediatric endocrinologist at the Cleveland Clinic’s main campus in Ohio, who was not involved in this research. “The underlying issue is that we have the growing prevalence of obesity due to the multiple social and environmental challenges in our world,” says Dr. Mucci. Prediabetes is one of the many complications of obesity, as are other factors, such as hypertension and high cholesterol, explains Mucci. “This is the trickle-down effect, mostly from the increasing prevalence of obesity. We’re diagnosing more and more children with type 2 diabetes,” she says. The definition of prediabetes is a challenging one, particularly in adolescents and children, according to Mucci. Hemoglobin A1C hasn’t traditionally been used in pediatrics, even to diagnose type 2 diabetes, until the last 10 years or so, says Mucci. “It’s less certain to use this measurement in children than in the adult population,” she says. Although experts might not agree on the best or most accurate way to determine prediabetes in a younger population, the trends in obesity and the higher incidence of type 2 diabetes are worrisome and need to be addressed, says Mucci. RELATED: Younger Diabetes Diagnosis Tied to Higher Heart Disease Risk “It’s important to note that when type 2 diabetes presents in children, it’s a much more aggressive disease than if it presents in adulthood,” says Mucci. “There are studies that show that once you develop full-blown type 2 diabetes, the complications such as kidney disease and eye problems are much more severe,” she says. A study published in August 2019 in Diabetes Journal found that disease-related complications usually seen in older populations could occur in those with youth-onset diabetes as early as their twenties. Diabetes carries financial burdens as well. In 2017, the total cost of healthcare to treat diabetes was $327 billion. The average person diagnosed with diabetes spends an average of $16,750 per year in medical expenses, more than twice as much as people without diabetes, according to the CDC.
Tips for Reversing or Avoiding Prediabetes for Children and Adults
Just because you have a diagnosis or label of prediabetes doesn’t mean you’re going to go on to have type 2 diabetes, according to Mucci. “It’s just a warning sign that you are at increased risk,” she says. Making changes isn’t easy, but it’s important, says Mucci. “A lot of the conveniences that have come with technology and society progressing are also barriers to maintaining healthy lifestyles.” Interventions in pediatric obesity are best approached in a family-based way, says Mucci. “For example, even if the parents are normal weight, if they’re drinking regular soda every day, we would encourage the whole family to make healthy changes and stop drinking it. It’s important that everyone is on the same page,” she says. In addition to dropping the sugary drinks, Mucci recommends the following lifestyle changes:
Increase fruit, vegetable, and overall fiber intake.Find ways the family can be physically active.Reduce portion sizes.Cut down on highly processed food and fast food.Reduce screen time: televisions, phones, tablets, and computers.
RELATED: A Comprehensive Guide to Using MyPlate for Healthy Eating Factors like where someone lives and their income level can make adopting these changes more challenging, says Mucci. “Some families feel that they can’t let their children walk or play outside because they don’t feel that their neighborhood is safe. There are people who don’t have the transportation or means to take their child to extracurriculars,” she says. Try to make improvements in the ways you can, she suggests. “Even if you’re eating fast food, water is less expensive than soda,” she says. “You don’t have to join the gym to get exercise — try to cut down on screen time and find ways to sit less and move more,” says Mucci. Although these trends need to be addressed through policy changes, that could take years or decades to solve, notes Mucci. “For now, families need to take action in trying to make healthier decisions,” she says. Young adults who are concerned that they may have prediabetes can take a simple one-minute online test on the CDC prediabetes website, says Imperatore. “If your score is high, take your results to your doctor and work together to make changes.” RELATED: Is Diet or Exercise More Important for Preventing Prediabetes?
