TOPLINE:
Among US adolescents aged 10-19 years, roughly 30% have prediabetes or type 2 diabetes (T2D), with boys accounting for 62% of cases. Abdominal adiposity, measured by waist-to-height ratio, emerged as the strongest independent predictor of prediabetes or T2D rather than BMI.
METHODOLOGY:
- Over the past two decades, the prevalence of prediabetes and T2D has risen sharply among adolescents in the US, driven by higher rates of obesity, sedentary behavior, and unhealthy dietary patterns. Despite this burden, most epidemiologic research has focused on older adults, leaving important gaps in knowledge about adolescents.
- Researchers analyzed data from the 2021-2023 cycle of the National Health and Nutrition Examination Survey to estimate the prevalence of prediabetes or T2D among 1998 adolescents (mean age, 14.2 years; 50.1% boys).
- Prediabetes or T2D was defined as an A1c level ≥ 5.7% or fasting plasma glucose ≥ 100 mg/dL; normal glucose was defined as an A1c level < 5.7% or fasting plasma glucose < 100 mg/dL.
- Participants underwent standardized anthropometric assessments including BMI categorization and waist-to-height ratio measurement; abdominal obesity was defined as a waist-to-height ratio ≥ 0.5.
- Demographic, lifestyle, dietary, and clinical and biochemical variables were also collected from the survey and laboratory data.
TAKEAWAY:
- Overall, the weighted prevalence of prediabetes or T2D was 30.8%, corresponding to nearly 1 in 3 adolescents; boys had a higher prevalence than girls (62.0% vs 38.0%), and non-Hispanic White adolescents had the highest prevalence across racial and ethnic groups (37.2%).
- Abdominal obesity emerged as the strongest independent predictor of prediabetes or T2D after adjustment for confounders (adjusted odds ratio [aOR], 146.19; 95% CI, 5.39-3976), whereas BMI status lost significance in multivariate analysis.
- Female sex was associated with lower odds of prediabetes or T2D than male sex (aOR, 0.52; 95% CI, 0.36-0.78).
- Older age was also associated with lower odds of prediabetes or T2D in adolescents (aOR, 0.91; 95% CI, 0.83-0.99).
IN PRACTICE:
“From a clinical and public health perspective, these findings suggest that screening strategies relying solely on BMI may miss high-risk adolescents. Integrating waist-to-height ratio into routine pediatric assessment could enhance early identification, particularly among males, and inform targeted interventions to reduce central adiposity before glycemic deterioration occurs,” the authors of the study wrote.
SOURCE:
The study was conducted by Eric Peprah Osei, University of Illinois Chicago. It was published online on February 25, 2026, in PLOS Global Public Health.
LIMITATIONS:
The study was cross-sectional; therefore, it could not establish a cause-and-effect relationship between the risk factors and the incidence of prediabetes or T2D. Single-point measurements of fasting glucose and A1c levels could have misclassified glycemic status in some cases. Self-reported diet and activity may have underestimated true exposure.
DISCLOSURES:
The authors reported receiving no specific funding for this work and declared having no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
