Prediabetes—a condition where blood sugar levels are higher than normal but not yet high enough to be considered diabetes—may pose a greater threat to younger adults than to older individuals, according to new research published August 7 in JAMA Network Open.
The study, led by researchers at the University at Buffalo, set out to clarify conflicting evidence about whether prediabetes increases the risk of death.
Previous research has shown mixed results, partly because important factors like age, race, and existing health conditions can influence the findings.
“We wanted to explore whether these factors influenced the association between prediabetes and mortality in a nationally representative U.S. adult population,” says first author Obinna Ekwunife, PhD, assistant professor of medicine at the Jacobs School of Medicine and Biomedical Sciences.
Using data from 38,093 adults who participated in the National Health and Nutrition Examination Survey (NHANES)—a long-running health survey run by the Centers for Disease Control and Prevention—the researchers found that 26.2% of participants had prediabetes.
This was determined either by self-reporting or by hemoglobin A1c levels between 5.7% and 6.4%, which reflect average blood glucose levels over the past three months.
Initially, the data suggested a significant link between prediabetes and higher mortality across all age groups. But after accounting for differences in demographics, lifestyle factors, and existing health conditions, this overall link disappeared.
However, the picture changed when the researchers looked specifically at younger adults aged 20 to 54. In this group, the association between prediabetes and mortality remained significant even after adjusting for other factors.
Why might younger adults be more at risk?
Ekwunife suggests that in older adults, the presence of other chronic illnesses may overshadow the effects of prediabetes. For younger people, however, prediabetes may indicate a more aggressive disease pathway, leading to earlier and more severe metabolic problems.
Other possible explanations include a stronger genetic predisposition to rapid disease progression and health disparities, such as reduced access to care or lower engagement in preventive health services among younger populations.
Regardless of the cause, the researchers believe the findings highlight the need for earlier screening for prediabetes in younger adults—especially those with additional risk factors like obesity, a family history of diabetes, or socioeconomic challenges.
“We may need to be doing A1C screenings earlier in younger people,” Ekwunife says. “Early detection can give patients an opportunity to make proactive lifestyle changes to prevent disease progression.”
He adds that diabetes-prevention programs should be tailored to better reach younger adults, perhaps by using virtual platforms, peer-led initiatives, or interactive tools like gamification to keep people engaged.
“Clinicians should recognize that early intervention could prevent both progression to diabetes and premature mortality,” he says. “This is a critical window for prevention.”
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Source: University at Buffalo.
