A new national study shows that prediabetes increases the risk of death for adults aged 20 to 54, but not for older age groups. Researchers say the results highlight the need for earlier screening and prevention efforts for younger Americans.
The research, published in JAMA Network Open by a team at the University at Buffalo, examined data from more than 38,000 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018.
Adults were tracked through mortality records from the National Death Index. Prediabetes was defined by self-reported diagnosis or hemoglobin A1c levels between 5.7% and 6.4%.
Overall, 26.2% of participants, representing more than 51 million U.S. adults, had prediabetes.
In unadjusted models, those with prediabetes had a higher all-cause mortality rate (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.43-1.74). After adjusting for demographics, lifestyle factors, and existing health conditions, the link between prediabetes and mortality largely disappeared (HR 1.05, 95% CI 0.92-1.19).
When broken down by age, the risk remained for adults aged 20 to 54. In that group, prediabetes was associated with a 68% higher risk of death (HR 1.68, 95% CI 1.25-2.20). No significant association was found in adults aged 55 and older or across racial and ethnic groups.
Researchers stressed that while the number of deaths in the younger age group was still relatively small, the results should be seen as a warning sign. “Clinicians should not dismiss prediabetes as benign, especially in younger, otherwise healthy adults. It represents a window of opportunity for prevention,” said study co-author Obinna Ekwunife, PhD.
Ekwunife added that the increased risk could be linked to other metabolic or behavioral issues such as insulin resistance, poor cardiovascular health, reduced access to care, or low participation in preventive health visits.
Lead author Leonard E. Egede, MD, MS, said the findings highlight the importance of tailored prevention programs for younger adults, including flexible, virtual, or peer-led options that fit into working-age schedules.
Elizabeth Selvin, PhD, of Johns Hopkins Bloomberg School of Public Health, who was not involved in the research, noted that the results align with earlier studies showing little mortality risk from prediabetes in older adults. She said current definitions capture many older individuals who may not face serious health consequences from mild glucose elevations.
The authors acknowledged the study’s limitations, including its observational design, reliance on some self-reported information, and lack of data on causes of death. Even so, they said the message is clear.
For younger adults, a prediabetes diagnosis should prompt immediate action on diet, exercise, sleep, and stress management rather than a wait-and-see approach.