Study Highlights Higher Mortality Risk in Specific Prediabetes Group

Understanding the Link Between Prediabetes and Mortality in Younger Adults

A recent study has revealed a significant association between prediabetes and increased mortality risk among younger adults, highlighting the need for targeted interventions. The research, led by Leonard E. Egede, MD, MS, from the University at Buffalo, utilized data from over 38,000 participants in the National Health and Nutrition Examination Survey (NHANES). The findings suggest that prediabetes is statistically significantly linked to higher mortality rates specifically in individuals aged 20 to 54 years.

The study found that prediabetes was associated with an increased risk of death (HR 1.64, 95% CI 1.24-2.17) within this age group. This result underscores the importance of tailored diabetes prevention programs designed for young adults. These programs could include flexible, virtual, and peer-led options to enhance accessibility and engagement. Routine screening and timely referrals to appropriate interventions are essential steps in addressing this growing concern.

Obinna Ekwunife, PhD, co-author of the study, emphasized that clinicians should not view prediabetes as a benign condition, particularly in younger, otherwise healthy adults. He described it as a "window of opportunity for prevention." However, he also noted that the actual number of deaths related to prediabetes remains low. While the findings should be taken seriously as an early warning sign, they do not warrant panic.

Previous research on the relationship between prediabetes and mortality has yielded conflicting results. A 2021 meta-analysis suggested a link between prediabetes and higher mortality, while a 2019 study found no such connection in older adults. In the current study, prediabetes initially showed a significant association with mortality (HR 1.58, 95% CI 1.43-1.74), but this significance disappeared in the fully adjusted model (HR 1.04, 95% CI 0.92-1.18).

Ekwunife explained that the goal of the study was to clarify whether prediabetes independently raises mortality risk and for whom. He speculated that the increased risk among younger adults might reflect other underlying factors, such as insulin resistance or poor cardiovascular health. Additionally, reduced access to care or lower engagement in preventive care could contribute to delayed diagnosis and treatment.

Elizabeth Selvin, PhD, from Johns Hopkins Bloomberg School of Public Health, who was not involved in the study, commented that the findings align with previous research showing that prediabetes in older adults is not strongly linked to mortality. She pointed out that the current definitions of prediabetes are broad, capturing many individuals who may not be at high risk for adverse outcomes, especially in older age groups.

In the study, prediabetes was defined using self-report or hemoglobin A1c levels ranging from 5.7% to 6.4%. The sample included 38,093 respondents, with 26.2% having prediabetes, representing more than 51 million U.S. adults. The majority of participants were between 20 and 54 years old, with a diverse demographic composition, including 51.9% women, 66.7% white, 11.4% Black, and 21.9% from other racial or ethnic backgrounds.

No significant associations were found among different racial and ethnic groups. In the 20 to 54 age group, 2.9% of those with prediabetes died compared to 2.3% without prediabetes. However, the causes of death were not identified in the study.

The researchers acknowledged several limitations, including the cross-sectional and observational nature of the study, potential self-report bias, lack of longitudinal tracking, and inability to determine specific causes of death. Despite these constraints, the study provides valuable insights into the relationship between prediabetes and mortality in younger adults.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute on Minority Health and Health Disparities. Egede reported receiving grants from the NIH, while Selvin disclosed funding from the NIH and the American Heart Association. She also serves as a deputy editor at Diabetes Care.