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

## TL;DR

One in three U.S. adolescents has prediabetes or type 2 diabetes, with central obesity being the strongest risk factor.

## Contribution

Identifies central adiposity as a stronger predictor than general obesity for prediabetes/T2DM in adolescents.

## Key findings

- 30.8% of U.S. adolescents had prediabetes or T2DM based on HbA1c or FPG levels.
- Waist-to-height ratio was the strongest independent predictor of prediabetes/T2DM.
- Early screening and prevention targeting central obesity and demographics are urgently needed.

## 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.