Prediabetes in American Teens Has Doubled in the Last 20 Years

African American teen Talking To Nurse

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Key Takeaways

  • Prediabetes in adolescents in the United States has doubled over the last 20 years, in part because more children are overweight and obese.
  • The childhood obesity epidemic is a complex phenomenon that is rooted in many social, environmental, and economic factors.
  • Experts are calling for more prevention and screening of teens for prediabetes. While it starts with a teen’s family, prevention also needs to include communities and schools.

In a recent letter published in JAMA Pediatrics, researchers reported that prediabetes in American teens has more than doubled over the last 20 years.

Experts say that more education, prevention, and screening of America’s youth is needed to help identify those at risk and prevent them from developing type 2 diabetes. 

What Is Prediabetes?

Prediabetes is a precursor to type 2 diabetes. A person with the condition has blood glucose (sugar) levels that are above normal but not yet in the diabetic range.

Rising Rates of Prediabetes

The study that went along with the letter used survey data from about 6,500 youth collected as part of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018.

In 1999, the rate of prediabetes in American youth was 11.6%. In 2018, it was 28.2%.

The data showed that the rates of prediabetes increased significantly among American teens aged 12–19, going from 11.6% in 1999 to 28.2% in 2018. 

Sejal Shah, MD, assistant professor of pediatric endocrinology and diabetes at Stanford Medicine and practitioner at the Lucile Packard Children's Hospital, told Verywell that their practice has seen an increase in prediabetes in teens over the years.

“The increased prevalence of pediatric obesity has been the largest contributing factor and has led to increased incidence of prediabetes and type 2 diabetes in youth,” Shah said.

The Importance of Screening

Experts say that screening for teens is key because prediabetes does not always have symptoms. Many people don’t realize they have the condition until it progresses to type 2 diabetes.

Routine prediabetes screening is standard for adults, but it’s currently only recommended for overweight children with one or more risk factors, including:

According to the American Diabetes Association (ADA), there are several tests providers can use to screen patients.

The most common are the hbA1c test, a fasting plasma glucose test, and an oral glucose tolerance test.

A1C Test

The hemoglobin A1c (HbA1c test) is a simple blood test that measures how much glucose is attached to red blood cells.

The value is written as a percentage that shows a person’s average blood sugar levels over the last three months.

A1C Ranges

  • Normal A1C: less than 5.7%
  • Prediabetes A1C: 5.7-6.4%
  • Diabetes A1C: 6.5% and higher

Fasting Plasma Glucose (FPG)

A fasting plasma glucose (FPG) test is a blood test that measures blood glucose levels when they should be at their lowest.

The test is done after a person has not had anything to eat or drink for at least eight hours (fasting). Usually, a person has their blood drawn first thing in the morning before they have breakfast.

FPG Ranges

  • Normal FPG: less than 100 mg/dl
  • Prediabetes FPG: 100 mg/dl to 125 mg/dl
  • Diabetes FPG: 126 mg/dl or higher

Oral Glucose Tolerance Test (OGTT)

The oral glucose tolerance test (OGTT) involves having a person drink a sweet beverage, then having their blood tested over a two-hour period to see how their body processes the sugar.

OGTT Ranges

  • Normal OGTT: less than 140 mg/dl
  • Prediabetes OGTT: 140 mg/dl to 199 mg/dl
  • Diabetes: 200 mg/dl or higher

The Role of Childhood Obesity

According to the Centers for Disease Control and Prevention (CDC), 1 in 5 adolescents ages 12–18 are currently living with prediabetes.

Pediatric or childhood obesity is defined as having a body mass index (BMI) in the 95th percentile. It is the leading cause of youth prediabetes in the United States, affecting 14.4 million American children.

The obesity epidemic is rooted in environmental, lifestyle, and cultural factors that promote poor health outcomes that can last a lifetime.

Diet, sedentary behavior, and parenting style can contribute to a child’s risk of being overweight or having obesity.

Factors linked to childhood obesity include:

  • Sugary beverages
  • Snack foods and fast food
  • Large portion sizes
  • Lack of physical activity
  • Not having access to safe outdoor spaces (e.g., public parks)
  • Unhealthy relationships with food (e.g., using food as a reward)
  • Psychological factors (e.g., depression, anxiety, stress)

Getting Communities Involved

The medical community has long been aware of the rising rates of prediabetes in American youth, which is why they’re calling for broader awareness—and action. If it’s identified and addressed, prediabetes is reversible.

Sejal Shah, MD

The prevention of prediabetes and type 2 diabetes in youth is rooted in improving nutrition and increasing physical activity and exercise.

— Sejal Shah, MD

While childhood obesity may start at home, there are also important factors that a child faces when they’re in the community and at school. Even broader factors, like public policy, also factor in.

Together, these factors can create a negative feedback system of circumstances that affect a child’s behavior and lifestyle choices. 

Shah said that the cause of rising rates of pediatric obesity “is multifactorial and communities require an approach that addresses these various aspects in a way that best addresses the diverse needs of its population.”

What Adults Can Do

The CDC outlines several ways that caregivers, families, schools, and communities can help promote healthy behaviors in youth, including:

  • Encouraging children to get 60 minutes of physical activity a day
  • Providing a well-balanced diet (fruits, vegetables, whole grains, protein) 
  • Limiting high sugar and high-calorie snacks and beverages
  • Supporting caregivers who choose to breastfeed
  • Improving healthy food options, promoting physical activity, and providing nutrition education at school
  • Increasing families’ access to healthy and affordable foods
  • Providing safe outdoor spaces for youth to walk, bike, and play

“The prevention of prediabetes and type 2 diabetes in youth is rooted in improving nutrition and increasing physical activity and exercise,” said Shah.

That said, teens can’t go it alone.

“Lifestyle modifications should be done together, as a family, with parents and siblings and other family members working together,” Shah said.

Outside the home, Shah said that “families should also be supported by their communities to be able to provide healthy, affordable food options, and safe spaces for physical activity and exercise.”

What This Means For You

If you’re caring for a child or teen, know that many factors in their lives can place them at risk for behaviors that could increase their risk of prediabetes.

Helping them make choices that support their health can help reduce their risk.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Wallace AS, Wang D, Shin JI, Selvin E. Screening and diagnosis of prediabetes and diabetes in US children and adolescents. Pediatrics. 2020 Sep;146(3):e20200265. doi:10.1542/peds.2020-0265

  3. American Diabetes Association. Understanding A1C.

  4. Centers for Disease Control and Prevention. 1 in 5 adolescents and 1 in 4 young adults now living with prediabetes.

  5. Centers for Disease Control and Prevention. Defining childhood weight status.

  6. Centers for Disease Control and Prevention. Childhood obesity facts: prevalence of childhood obesity in the United States.

  7. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015;4(2):187-92. doi:10.4103/2249-4863.154628

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By Amy Isler, RN, MSN, CSN
Amy Isler, RN, MSN, CSN, is a registered nurse with over six years of patient experience. She is a credentialed school nurse in California.