Prevalence and predictors of prediabetes/type 2 diabetes mellitus among adolescents in the United States: NHANES (2021–2023)

Abstract

Prediabetes and type 2 diabetes mellitus (T2DM) are emerging public health concerns among adolescents in the United States (U.S.), with early onset increasing the risk of lifelong complications. This study analyzed the prevalence and factors associated with prediabetes/T2DM among 1,998 adolescents (10–19 years) in the U.S. using data from the National Health and Nutrition Examination Surveys (2021–2023). Prediabetes/T2DM were defined as hemoglobin A1c (HbA1c) ≥ 5.7% or fasting plasma glucose (FPG) ≥ 100 mg/dL. Unweighted univariate and multiple logistic regression models were used to identify predictors of prediabetes/T2DM among adolescents. Overall, 30.8%—nearly 1 in 3 American adolescents—had prediabetes or T2DM. In univariate analysis, older age (OR = 0.93, p = 0.045), female gender (OR = 0.50, p = 0.001), overweight/obesity (OR = 1.57, p = 0.012), elevated waist-to-height ratio (OR = 24.04, p = 0.002), total daily sugar intake (OR = 1.003; p = 0.042), low HDL cholesterol (≤45 mg/dL) (OR = 1.41; p = 0.032), higher systolic blood pressure (OR = 1.02, p = 0.002) and higher diastolic blood pressure (OR = 1.02, p = 0.037) were significantly associated with the odds of having prediabetes/T2DM. However, in multiple logistic regression analysis, significant predictors included older age (AOR = 0.91; p = 0.025), female gender (AOR = 0.52; p = 0.002), and elevated waist-to-height ratio (AOR = 146.19; p = 0004). Although male gender and younger age showed increased risk, central adiposity—specifically measured by waist-to-height ratio—emerged as the strongest independent predictor of prediabetes/T2DM compared to general overweight/obesity (BMI). These findings underscore the need for early screening and targeted prevention strategies focusing on central adiposity and demographic risk factors.