Linda J. Andes, PhD, on Tackling Prediabetes in US Teens and Young Adults

New research published in JAMA Pediatrics indicates that 1 in 5 adolescents and 1 in 4 young adults in the United States have prediabetes.¹

These findings emerged from cross-sectional analyses of data from the 2005-2016 National Health and Nutrition Examination Survey.¹ A total of 5786 individuals (2606 adolescents and 3180 young adults) were included in the analyses.¹

In addition to identifying the prevalence of prediabetes in adolescents and young adults, the results of the study indicated its prevalence was higher in male compared with female individuals and in those with obesity overall.¹ Furthermore, adolescents and young adults with prediabetes were found to have significantly higher non–high-density lipoprotein cholesterol levels, systolic blood pressure, central adiposity, and lower insulin sensitivity compared with individuals with normal glucose tolerance.¹

Lowering rates of prediabetes and obesity in the United States is key for prevention, as prediabetes is associated with an increased risk of subsequent health complications. “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,” the authors of the study wrote.¹

Consultant360 spoke with lead author Linda J. Andes, PhD, from the Centers for Disease Control and Prevention (CDC), about the importance of risk stratification, addressing the obesity epidemic, and other efforts geared towards lowering rates of prediabetes in US youth.

Consultant360: How can the findings from your study aid in risk stratification?

Dr Andes: Researchers found that the rates of adolescents and young adults living with prediabetes was higher in males and in participants with obesity. In order to mitigate the risk of developing prediabetes in these groups, health care providers can help by measuring children’s weight and body mass index routinely, and testing the child for prediabetes if appropriate. Providers should also refer families to nutrition education or childhood and youth healthy weight programs as needed.

C360: Your study found that the prevalence of prediabetes is significantly higher in patients with obesity vs patients with normal weight. What role does combatting the obesity epidemic play in reducing rates of prediabetes in adolescents and young adults?

Dr Andes: Until recently, young children and adolescents almost never developed type 2 diabetes, which is why it used to be called adult-onset diabetes. Now, about one-third of American youth are overweight, and this is probably related to the increase in type 2 diabetes in youth.

In adults with prediabetes, lifestyle modifications aimed at reducing body weight by 5% to 7% have resulted in a 58% reduction in the occurrence of type 2 diabetes.² These interventions have not yet been evaluated in adolescents with prediabetes. For young adults with prediabetes participation in structured lifestyle changes programs, like the CDC-led National Diabetes Prevention Program, can reduce the risk of progression to type 2 diabetes.

C360: What is the key take-home message of this study?

Dr Andes: Adolescents and young adults with prediabetes are at increased risk of developing type 2 diabetes, chronic kidney disease, and cardiovascular disease. If a child is overweight and has other risk factors for type 2 diabetes (ie, has a family member with type 2 diabetes, was born to a mom with gestational diabetes, is African American, Hispanic/Latino, Native American/Alaska Native, Asian American, or Pacific Islander, or has one or more conditions related to insulin resistance), it is appropriate to measure the child’s blood sugar. Testing typically begins at 10 years old or when puberty starts, whichever is first, and is repeated every 3 years.

Parents have also the power to make healthy changes that give kids the best chance to prevent type 2 diabetes by implementing healthier eating habits and encouraging increased physical activity. Health care practitioners should encourage parents to aim for their child to get 60 minutes of physical activity a day, in several 10- to 15-minute sessions or all at once.

C360: What are the next steps in terms of future research?

Dr Andes: In adults with prediabetes, primary prevention intervention trials have demonstrated that type 2 diabetes can be prevented or delayed with lifestyle modifications. However, similar studies have not been conducted in the adolescent population. Therefore, future studies are needed to assess whether these interventions with demonstrated efficacy in adults are similarly effective in adolescents with prediabetes.

—Christina Vogt

References:

1. Andes LJ, Chang YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016 [Published online December 2, 2019]. JAMA Pediatr. doi:https://doi.org/10.1001/jamapediatrics.2019.4498.
2. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Eng J Med. 2002;346:393-403. doi:10.1056/NEJMoa012512.