Prediabetes in American Teens Has Doubled in the Last 20 Years

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. 

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.

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:

• Non-White race
• Family history of type 2 diabetes
• Maternal gestational diabetes
• Signs of insulin resistance

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.

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.

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.

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.

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.

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.”