About 1 in 3 young people who are 12 to 17 years old have prediabetes, new national data show, putting them at risk not just for type 2 diabetes but also for heart disease and stroke. Developing chronic diseases early in life also heightens their chances for worse outcomes from these conditions. 

Experts said the data reflect a concerning rise in obesity among teens, but also noted that not all teens with prediabetes will progress to diabetes.

The new report from the Centers for Disease Control and Prevention relied on the long-running National Health and Nutrition Examination Survey, which asked adolescents if they’d ever been diagnosed with diabetes and analyzed results of their fasting blood glucose or hemoglobin A1c tests. Its conclusion: In 2023, an estimated 8.4 million adolescents, or 32.7% of 12- to 17-year-olds, had prediabetes.

“These new prediabetes data among adolescents serve as a wake-up call. Type 2 diabetes is a significant threat to the health of our nation’s young people,” Christopher Holliday, director of CDC’s Division of Diabetes Translation, said in a statement Tuesday. “The good news is it’s not too late to change course. Simple lifestyle changes — like healthy eating and staying active — can make a big difference in preventing or delaying type 2 diabetes.”

Statistical changes in how the information was gathered and studied make comparisons difficult, but when the methods used this time were applied to the previous estimate from NHANES, the prevalence of prediabetes for 2015 through 2016 in the same age group would have been 28%, the report says. Previous estimates have been closer to 20%. The new report is based on data from two time periods: 2017 through March 2020, and August 2021 through August 2023.

The trend toward greater prevalence of prediabetes among young people is backed up by evidence from the National Institutes of Health, among other studies. The increase also aligns with trends in new diabetes diagnoses among adults age 18 and older. After declining for more than 10 years, adult rates have begun to climb again, adding up to about 1.5 million new diabetes diagnoses in 2023, the CDC also said, citing the most recent data.


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Not every child with prediabetes, as confirmed by blood tests, will go on to develop type 2 diabetes, Meg Bensignor, a pediatric endocrinologist at the University of Minnesota’s Center for Pediatric Obesity Medicine, told STAT. She was not involved in the NHANES study. But the higher a BMI or A1C when diagnosed, the more weight gained, and the more adverse social drivers of health a child has, the higher the risk of developing type 2.

“If you have prediabetes, that already tells you that your pancreas and your beta cells specifically are under a lot of stress, and certainly we know that kids with type 2 diabetes lose beta cell function much more quickly than adults,” Bensignor said. “I pretty much treat everyone as if they’re going to develop type 2 because we don’t know, and getting type 2 in kids can be really devastating with a lot of comorbidities early in their life.”

Nancy Crimmins, a pediatric endocrinologist at Cincinnati Children’s Hospital Medical Center who started a prediabetes clinic at the hospital, emphasized the lack of clarity around who will and who won’t move from prediabetes in adolescence to type 2 diabetes. She was not involved in the NHANES study, but pointed out that previous NHANES reports estimated that about 70% of youth with prediabetes go back to normal glycemic measures after puberty. Other studies show a wide range of progression, saying anywhere from 45% to 75% revert back to normal from prediabetes.

“When you look at the sheer numbers who have prediabetes, especially in adolescence, versus how many adolescents have type 2, that number drops off a lot,” she told STAT. “One of the huge questions in our field is, can we identify who those kids are who are going to progress to type 2 and who aren’t?” 

One explanation: Puberty plays a role in prediabetes, Crimmins said. Growth hormone and other hormonal changes make teens more insulin resistant during puberty.

Crimmins still called type 2 diabetes in children a very aggressive disease and an important one to prevent. 

Bensignor noted that the CDC report does not distinguish among precursors for type 1, type 2, or genetically related diabetes — something needed to be defined before planning a prevention strategy. Some genetic mutations that lead to diabetes are inherited, and type 1 and type 2 have different causes. 

In the much more common type 2 diabetes, beta cells in the pancreas lose the ability to make enough insulin, or the insulin they makes doesn’t work properly. In type 1, affecting about 10% of people with diabetes, the immune system mistakenly destroys insulin-producing pancreatic islet cells, meaning they can’t make insulin to process glucose into energy. 

Distinguishing which type a child has is important in type 1, where not recognizing low insulin is dangerous.

Certain factors prompt testing a child for prediabetes. The American Diabetes Association recommends screening children age 10 and older who have a BMI higher than the 85th percentile for their age, plus one other factor. That includes whether their mother had gestational diabetes or there’s a family history of type 2 diabetes. Beyond these risk factors are the social drivers of health, including limited access to healthy food and opportunities to be physically active. Because these social determinants are closely linked to race and ethnicity, screening automatically includes nonwhite children.

Physical examinations can also be key. Darkening and thickening of the skin, skin folds, or skin tags may be signs of a body pumping out high and unhealthy amounts of insulin.

“What we need to be doing is really treating it seriously in all the kids, at the same time not scaring the families that we do see this during a pubertal window,” Crimmins said. “It doesn’t mean that your child will develop type 2 diabetes in the childhood period.” 

The field is catching up to a phenomenon that’s been developing only in the last 20 to 30 years, Bensignor and Crimmins said. A new NIH-funded effort, called the DISCOVERY trial, seeks to define who among children with prediabetes will develop type 2.

“This data, along with others, just really cements that there needs to be scientific funding of more research to really understand how to best treat kids,” Bensignor said. “We just need more research to really understand how to prevent and then also how to effectively treat kids that do develop type 2 diabetes.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.