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About a quarter of young adults in the U.S. met the criteria for prediabetes in recent years, according to new CDC data.

In a cross-sectional analysis of the 2005-2016 National Health and Nutrition Examination Survey, 24% of individuals ages 19 to 34 were considered to have prediabetes (95% CI 22.0%-26.1%), reported Linda Andes, PhD, of the CDC in Atlanta, and colleagues.

This issue also afflicted younger Americans, as about 18% of adolescents from ages 12 to 18 met the criteria for prediabetes (95% CI 16.0%-20.1%), the group wrote in .

"The prevalence of prediabetes in adolescents and young adults reinforces the critical need for effective public health strategies that promote healthy eating habits, physical activity, and stress management," explained CDC director Robert Redfield, MD, in a statement. "These lifestyle behaviors can begin early in a child's life and should continue through adolescence and adulthood to reduce onset of type 2 diabetes."

The researchers utilized three different criteria for defining prediabetes:

• Impaired fasting plasma glucose of 100 to 126 mg/dL

• Impaired glucose tolerance with a 2-hour plasma glucose of 140 to 200 mg/dL

• Elevated HbA1c level of 5.7% to 6.4%

Most of the individuals identified as having prediabetes in the analysis met the criteria for impaired fasting glucose -- 11.1% (95% CI 9.5%-13.0%) of adolescents and 15.8% (95% CI 14.0%-17.9%) of young adults.

In a predictive model, male adolescents had nearly double the prevalence of prediabetes compared with females -- 22.5% (95% CI 19.5%-25.4%) versus 13.4% (95% CI 10.8%-16.5%). A similar trend was seen among young adults, with men (29.1%, 95% CI 26.4%-32.1%) having a significantly higher prevalence of prediabetes compared with women (18.8%, 95% CI 16.5%-21.3%). These predictive models were also adjusted for age, sex, race, and body mass index (BMI).

The researchers said that unsurprisingly, a higher prediabetes prevalence was seen among individuals with obesity versus those of normal weight. Specifically, 36.9% (95% CI 32.9%-41.1%) of young adults with obesity had prediabetes compared with only 16.6% (95% CI 14.2%-19.4%) of normal-weight adults. In a similar trend, 25.7% (95% CI 20.0%-32.4%) of adolescents with obesity met the criteria for prediabetes versus only 16.4% (95% CI 20.0%-32.4%) of normal-weight adolescents.

Another non-surprise was that young people who had prediabetes tended to have several increased metabolic risk factors, as well, the investigators added. For adolescents, those with prediabetes had significantly higher systolic blood pressure (SBP), non-high density lipoprotein cholesterol, waist-to-height ratio, BMI, and fasting insulin, and lower insulin sensitivity:

• SBP: 112.6 vs 108.5 mm Hg

• Cholesterol: 109.3 vs 101.6 mg/dL

• Waist-to-height ratio: 0.51 vs 0.49

• BMI: 25.1 vs 23.5

• Fasting insulin: 5.0 vs 4.4 μU/mL

• Insulin sensitivity: 7.9 vs 8.6 single point insulin sensitivity estimator

The same trends were reported among young adults, with those with prediabetes having a significantly worse cardiometabolic profile, as follows:

• SBP: 117 vs 113.4 mm Hg

• Cholesterol: 132.8 vs 101.6 mg/dL

• Waist-to-height ratio: 0.59 vs 0.53

• BMI: 30.8 vs 26.7

• Fasting insulin: 5.1 vs 4.0 μU/mL

• Insulin sensitivity: 5.6 vs 6.9 single point insulin sensitivity estimator

Study limitations, Andes and co-authors said, included that since the defining clinical criteria for prediabetes -- fasting plasma glucose, 2-hour plasma glucose, and HbA1c levels -- were measured only at one point in time, some individuals may have been misclassified. Still, the team said, despite this limitation, the findings underscore a need for greater diabetes prevention efforts, particularly aimed at younger people.

"These new findings are evidence of a growing epidemic and a tremendously worrisome threat to the future of our nation's health," noted Ann Albright, PhD, director of CDC's Division of Diabetes Translation, in a statement. "Additional research is needed to support the development of interventions for youth and increasing access to programs that we know work for young adults, like the CDC-led National Diabetes Prevention Program."

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