Prediabetes & Type 2 Diabetes in Youths

Dr Jedha, Host

Hello wonderful people, Dr Jedha here and thanks for joining me today for a chat about a very important topic. There’s been some quite shocking statistics come out of the CDC in the US that  1 in 3 children and adolescents now has prediabetes, that’s 8.4 million teens between the ages of 12 and 17, in the US alone. Think about that for a moment, a third of young people already showing early signs of blood sugar dysregulation. That’s a shocking statistic and it’s very concerning. 

Actually, it’s pretty darn crazy. Type 2 diabetes was once called “adult onset diabetes” because we’d only see it later in life, middle age and about. It rarely occurred in children, adolescents or young adults, rarely. The shift started in the 1990s, particularly in the US, when reports began showing more cases of type 2 diabetes in adolescents. By the early 2000s, the term adult-onset diabetes was officially dropped because it no longer reflected reality, young people were increasingly being diagnosed.

The reality today is very different. We are now seeing prediabetes and type 2 diabetes diagnosed in high schoolers, in young adults in their twenties and thirties, and even in children. And here is the part that should really make us stop and pay attention, when type 2 diabetes develops earlier, it is not just starting sooner, it is more aggressive, and it comes with a higher risk of complications over a lifetime.

I think it’s important to share these facts with you, because maybe you can educate people around you, build awareness and even in some small way, help combat this growing issue. In fact, we’ll leave a fact sheet on our website that you can go download, print up and share, so go grab that. This is not just a problem for the future. It is happening right now, and the choices we make, as individuals, families, and communities, will shape the health of an entire generation. 

Firstly, let’s cover briefly what prediabetes means, as we have all types of listeners, some of who may be parents or loved ones who don’t know what prediabetes means. Prediabetes is when blood sugar levels are higher than normal, but not high enough to meet the criteria for type 2 diabetes. Medically, this is defined as an A1c between 5.7 and 6.4 percent, or a fasting blood glucose between 100 and 125 milligrams per deciliter, or 5.6 to 6.9 millimoles per liter.

Prediabetes is a warning sign, an alarm bell that the body is already struggling with insulin resistance, blood sugar control and nutrient regulation – the body’s metabolism is altered, off balance. And…if nothing changes, many of these young people will go on to develop type 2 diabetes, and that progression can happen quickly.

The concern is even greater when prediabetes starts at a young age. If a teenager develops prediabetes, they will be living with high blood sugar and insulin resistance for many years longer than someone who first develops it in middle age. That long-term exposure sets the stage for serious complications like heart disease, kidney damage, nerve issues, and vision loss, often appearing much earlier in life.

Research also shows that prediabetes in younger adults carries a higher risk of premature death compared to those who develop it later in life. So this is not a harmless condition. For young people, it signals a very real health risk that needs urgent attention. Urgent attention, because among children and adolescents aged 10 to 19, the incidence of type 2 diabetes continues to creep upward year on year.

When we look beyond the US, it becomes clear that this is not just an American problem, it’s a global problem. In the UK, the number of people under 40 with prediabetes has jumped by around 25% in recent years. Even more concerning is that the number of people being diagnosed with type 2 diabetes in this same younger age group have risen by about 40% as well. That means tens of thousands of young adults in their twenties and thirties are now living with a condition that used to belong almost entirely to middle-aged adults. Australia is seeing the same shift. Over the past decade, there has been a 44% increase in type 2 diabetes among people aged 21 to 39, and among those under 21 years old, diagnoses have climbed by about 17%. If we zoom out to a global view, data also reveals shocking increases in type 2 diabetes diagnosis in people 15 to 39 years. So when we bring all this data together, we’ve seen huge jumps in a relatively short period of time, and they show how fast this condition is spreading among younger people. Prediabetes and type 2 diabetes in young people are no longer rare, isolated issues. They are accelerating trends across countries, cultures, and continents. And that raises the question we need to address next, why is this happening. What is driving this surge in numbers among young people?

The answer is complex, but the research points to several key factors.

First, obesity and diet. Childhood and adolescent obesity rates have skyrocketed since the 1970s, and the rise in type 2 diabetes tracks right alongside it. Diets are now dominated by ultra-processed foods, refined grains, and sugary drinks, which are directly linked to insulin resistance and issues with blood sugar control. Many young people are eating more calories and less nutrient dense food than ever before.

Second, physical activity has dropped to historically low levels. Teens today often spend six to nine hours a day on screens outside of schoolwork. That amount of sedentary time is not only replacing exercise, it is directly contributing to insulin resistance. Most adolescents are not meeting even the basic guideline of sixty minutes of moderate activity per day.

Third, sleep and stress. Short sleep duration, less than seven hours, is becoming the norm for teenagers, and poor sleep is tightly linked with insulin resistance, increased food intake and weight gain. In fact, studies show that increasing sleep by one hour over just one week improved insulin sensitivity in adolescents aged 13-18 years. On top of that, mental health struggles, social pressures, and academic demands all contribute to chronic stress. Elevated stress hormones like cortisol can worsen blood sugar control and make weight management even harder.

Fourth, family history and genetics. Some young people are genetically predisposed to developing diabetes, but what is happening today is that these inherited risks are being triggered earlier because of the food environment, inactivity, and stress. What might once have shown up in midlife is now appearing in adolescence.

Fifth, environmental and systemic factors. Parental education, access to healthy food, communities with more fast food outlets and fewer grocery stores, are all clear factors for higher rates of diabetes in their youth. The reality is that big food companies dominate our food supply with ultra-processed foods, they make it cheap and palatable, addictive, and every single environment we’re in generally presents these foods, rather than providing healthy food options. Lack of education about nutrition and its influence on our health, is also a major factor. The medical model is not health driven, we react to issues rather than invest in prevention, and again, lack of education on these factors is a big issue. 

And finally, there is emerging evidence that the COVID pandemic may have played a role. Some studies suggest an increase in type 2 diabetes diagnoses in young people following COVID infection, especially in those already overweight or obese. The research is still developing and no doubt in time we’ll see more data emerging on this, but it adds another layer of complexity to this growing problem.

This rise in prediabetes and type 2 diabetes in youth is the result of multiple forces converging. Most of these factors, however, are modifiable factors. And the concern is that unless these trends are addressed, we will see more young people not only developing diabetes but living with the complications of it much earlier in life. It is a major, major concern, because what it means for our young people’s health is alarming. 

So far we’ve looked at how common prediabetes is in young people, and why those numbers are rising. Now we need to ask, what does this actually mean for their health.

One study on this question was published in JAMA earlier this year. Researchers looked at more than 38,000 adults and followed them for mortality outcomes. When you look at prediabetes across the whole adult population, once you adjust for lifestyle and other health conditions, prediabetes itself did not always increase the risk of death. But when they focused on younger adults aged 20 to 54, the picture changed dramatically. In this age group, having prediabetes was linked with a 68% higher risk of dying earlier in life.

We now know that changes in the blood vessels start very early. Studies show that adolescents with insulin resistance, prediabetes, or type 2 diabetes already have endothelial dysfunction, a loss of healthy vessel flexibility that is the first step toward atherosclerosis and heart disease. In obese youth with prediabetes, researchers have found thicker artery walls and stiffer arteries compared with their peers, even after accounting for weight. That means vascular damage is happening in the teenage years, not decades later.

When type 2 diabetes develops in youth, and of course that begins on the spectrum from prediabetes, the complications can appear shockingly fast. Let’s look at data from the TODAY study, which followed adolescents with type 2 diabete aged between 10 and 17 years. At the start of the study 1 in 10 young people had high blood pressure. Aver an average of only 3.9 years in the study, this rose to one third of young people having high blood pressure. Kidney disease—a little over 6% at the beginning of the study, that was within 2 years of their type 2 diagnosis. These rates tripled in less than 4 years. The TODAY2 study kept following these youths into their mid 20s, so in the second phase of the study, these young people were 13.3 years on average since their diagnosis. The results of this study were even more alarming. 67.5% had high blood pressure, 51.6% had high cholesterol, 54.8% had kidney disease, 32.4% had nerve disease and around 51% had eye complications, 13.7% of those with advanced eye complications. 60% of these young people had at least one complication and 28.4% had at least two complications. I’m sure you will agree, these are very disturbing numbers, and they are very real consequences for our young people. These are complications we normally associate with people in their fifties or sixties who have had diabetes for decades, yet they are showing up in young adults in their mid twenties. 

And this is not just what we see in controlled clinical studies like TODAY. A massive new analysis of nearly 8 million people with type 2 diabetes, published in 2025, shows the same pattern in the real world. The steepest rises in complications are happening in those under 35. In this group, rates of kidney disease rose by more than 1100%, nerve disease by almost 900%, eye disease by more than 200%, and heart failure increased by over 400%, while stroke rates went up by more than 200%.. Older adults still had higher absolute rates, but the relative acceleration in the younger people, under 35, is staggering, crazy…

This is what makes youth-onset diabetes so aggressive. It doesn’t just begin earlier, it progresses faster and causes damage sooner. The lifetime burden of disease is far heavier, and the window to intervene is much shorter. For young people, prediabetes and diabetes are not harmless labels. They are red flags pointing to real risks for the heart, kidneys, eyes, and blood vessels that can start unfolding within just a few short years.

Okay, so we know prediabetes in youths and the subsequent development of type 2 diabetes portrays a terrible future for our young people. But now we get into the tricky debate of how it is being treated. In our current treatment model, medications are a predominant solution provided to adults—even though they are not really a solution. For adolescents and young adults, the options for medications are very limited. I hope it stays that way. But, with these rising rates, we are seeing new research on drugs. For many years, the only approved drugs for type 2 diabetes in children were metformin and insulin. Now SGLT-2 inhibitors are being studied in youths. a recent clinical trial tested canagliflozin in adolescents with type 2 diabetes. At 26 weeks, it lowered A1c by about 0.7 percent compared to placebo, and more than a third of the participants on the drug achieved an A1c below 6.5 percent. These are meaningful results, and the safety profile looked similar to adults. So many people and clinicians would look at that and thing, well these medications look great, all kids should be put on these to help them. 

But here is the major concern. If we start children and teenagers on these medications, many of them will stay on drugs for life, and probably not just one. In the TODAY study, which followed youth with type 2 diabetes over time, more than one-third of those who started on blood pressure medications eventually needed multiple medications to control it. That is a powerful example of how quickly polypharmacy—the prescription of multiple medications—can begin in this group. A teenager on metformin may later be prescribed another diabetes drug, then a blood pressure drug, then a cholesterol drug, and so on. By their twenties or thirties, they could be managing several prescriptions daily, with all the risks of side effects, interactions, and treatment fatigue that come with it.

And yet, even with medication, youth-onset diabetes remains very aggressive. Drugs can help lower A1c and control certain risk factors, but they have not been enough to stop the rapid progression of complications we talked about earlier. This raises an important question: should we really be putting so much emphasis on medications for young people, or should we be focusing far more on prevention and nutrition and lifestyle-based strategies that address the root causes.

I’m sure you can guess what my answer is. Relying on medication is dangerous, especially at these younger ages. While on the opposite spectrum, studies show diet and exercise are extremely effective for treatment of prediabetes and type 2 diabetes in youth. Making changes to nutrition quality and increasing activity can help improve weight, insulin resistance and improve blood sugar, but more importantly, it can help improve endothelial function, that’s an improvement in blood vessel health and a reduction of other cardiovascular risk factors such as reduced inflammatory molecules and an increase in beneficial endothelial cells and a decrease in the negative microparticles. 

After hearing the statistics and the health risks, it might feel overwhelming—that’s because it is, it is overwhelming, alarming, worrisome, unsettling, tragic, and very sad. So what can we do about it? Well, prediabetes and type 2 diabetes in young people is not an inevitable outcome. There are proven ways to prevent progression and, in many cases, to turn things around. We know this is true for adults and certainly, we know the same for children, adolescents and young adults.

The first and most powerful step is early screening. Right now, many young people are not even being tested for blood sugar problems until the disease has already advanced. For children and adolescents who are overweight, have a family history of diabetes, or belong to higher risk groups, simple blood tests like fasting glucose or A1c can identify problems early. Catching prediabetes early gives us a valuable window of opportunity to act before complications begin. So if you’re a parent, grandparent, scout leader, or work in any capacity among children and adolescents, educate people about seeking these tests. 

Next, nutrition and lifestyle changes are paramount. Nutrition plays a central role in anyone’s health and for young people nutrition is critical and even small shifts can make a big difference. For young people, some of the simplest things we can do is help them cut down on sugar, sugar-sweetened beverages and ultra-processed foods—take them out of your environment. Don’t reward young people with sweets, find more valuable rewards that nurture health or self-care. Think about this—and as a grandmother of 3 I now have to be aware of this too, because rewarding with sweets is such a common habit and it unintentionally reinforces the very patterns that contribute to poor metabolic health. There are so many more valuable ways to reward our young people that also foster healthier long term behaviors and self-care. For instance, reward experiences over sweets, extra time doing something they enjoy such as a bike ride, swimming, game time, arts and crafts, or music. Reward small privileges that feel special such as staying up 15–20 minutes later on the weekend. Reward with tangible but healthy rewards such as stickers, stamps, or tokens that build toward a bigger non-food prize. Reward with words and recognition by giving verbal praise that highlights effort, not outcome or through achievement charts, or family “shout-outs” that celebrate progress.  Reward with self-care and relaxation like a special at-home spa activity or a new hobby kit. There are so many ways we can reward, without including sweets and junk foods. In fact, I will leave a downloadable list of ideas in the show notes. But back to the point—remove sugar, sugar-sweetened beverages and ultra-processed foods from the environment. Bring in more whole foods like vegetables, protein, and healthy fats, and reducing the overall carbohydrate load can improve blood sugar control quickly. And these are changes that can be done at a family level, so everyone benefits together.

Movement is another key factor. The goal is not about forcing kids into gyms, it is about finding enjoyable ways to move more. We didn’t have screens as a kid, we were always out playing, running around, riding bikes and that’s what we need to encourage. Walking, playing sports, dancing, biking, or even short bouts of movement after meals can help lower blood sugar. The World Health Organization recommends at least sixty minutes of moderate activity daily for youth—just one hour, that’s nothing. And again, this can be done at a family level, so everyone benefits together.

We also can’t ignore sleep and stress. Prioritizing consistent sleep schedules, aiming for at least eight hours for teens, and addressing stress through mindfulness, providing supportive environments and encouraging relaxation can significantly improve insulin sensitivity. But we don’t want to encourage relaxation through screen time but other ways – time in nature and green space, a walk, a picnic or such. These may seem like small lifestyle habits, but they have a major impact.

At the broader level, families, schools, and communities all play a role. Access to healthier foods in school cafeterias, safe environments for activity, and education about nutrition can set young people on a healthier path. Digital programs, peer support groups, and age-appropriate resources can also increase engagement, especially since so many young people live online.

And finally, we need to see prevention as the most important intervention. Medications will always have a place, but if we can delay or prevent the need for them through lifestyle approaches, we’re not just reducing side effects, we are giving young people the chance for healthier and longer lives.

The bottom line is this, early intervention works. Whether that means catching prediabetes through screening, supporting healthier food choices, encouraging more movement, or making sleep and stress management a priority, each small change can add up. The earlier we start, the better the outcomes.

So to bring this all together, we are facing a very real and urgent issue. Millions of young people around the world are now living with prediabetes, and far too many are progressing to type 2 diabetes at ages we never used to see. The data shows us clearly that this is not a slow-moving problem. It is aggressive, it is life-shortening, and it is already setting the stage for serious complications in teens and young adults.

But I want to leave you with hope. Prediabetes and type 2 diabetes are not destiny. Early screening, awareness, and simple changes in daily life can make a tremendous difference. Swapping out sugary drinks, creating healthier food environments, moving our bodies more, getting enough sleep, managing stress, and most importantly, supporting our kids with encouragement rather than quick-fix rewards like sweets — these are the things that protect health and help young people thrive.

The choices we make as parents, grandparents, teachers, health professionals, and community members really matter. Every time we educate, every time we create a healthier environment, every time we set an example, we are shifting the future for this next generation.

So I encourage you, take what you’ve learned today and share it. Remember, you can download a fact sheet on our website and a list of ideas on rewarding kids with things other than sweets and foods. Talk with your family, your friends, your colleagues. Help build awareness. And let’s work together to change the trajectory of this growing epidemic, so our young people can live long, healthy, vibrant lives.

Thank you so much for joining me today. 

Take care of yourself and those you love. 

Until next time.

Dr Jedha, over and out.