Prediabetes: Risk of Type 2 Diabetes Varies by Age & Health Factors

A nuanced understanding of type 2 diabetes risk in young adults with prediabetes is emerging, suggesting a “one-size-fits-all” prevention approach may not be optimal. Preliminary research presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026, held in Boston March 17–20, indicates that risk varies considerably based on factors like fasting glucose levels and eligibility for newer weight-loss medications. This finding underscores the need for more tailored interventions to prevent progression to type 2 diabetes, a condition increasingly diagnosed in those under 40.

The rising incidence of both prediabetes and type 2 diabetes in younger populations is a growing concern. Complications associated with type 2 diabetes – including heart disease, kidney disease, stroke, and nerve damage – can significantly impact quality of life and longevity. Early intervention is crucial, but determining which individuals with prediabetes are at the highest risk, and therefore would benefit most from intensive prevention strategies, has been a challenge.

Risk Stratification and GLP-1 Receptor Agonists

The study, led by Mary Rooney, Ph.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, explored the potential of using existing criteria for GLP-1 Receptor Agonist (GLP-1RA) medications – a newer class of drugs approved for weight loss and type 2 diabetes management – to identify those at elevated risk. GLP-1RA medications, such as semaglutide and liraglutide, are approved by the FDA for individuals with obesity (a body mass index of 30 kg/m² or higher) or overweight (BMI of 27 kg/m²) plus a weight-related health condition like high blood pressure or high cholesterol. Currently, these medications are not FDA-approved for preventing type 2 diabetes in those with prediabetes.

Researchers analyzed data from 662 young adults (ages 18-40) followed for an average of seven years through three U.S.-based studies: the Hispanic Community Health Study/Study of Latinos, the Coronary Artery Risk Development in Young Adults study, and the Framingham Heart Study Third Generation. The analysis revealed a baseline 5-year risk of progressing from prediabetes to type 2 diabetes of 7.5% overall. However, this risk increased significantly in specific subgroups.

• For individuals meeting the criteria for GLP-1RA treatment based on weight and related conditions, the 5-year risk rose to 10.9%.
• Those with higher fasting glucose levels (110-125 mg/dL) experienced a 5-year risk of 15.1%.
• The highest risk – 24.8% – was observed in individuals with both higher fasting glucose and eligibility for GLP-1RA medications.

“Current approaches to type 2 diabetes prevention are ‘one-size-fits-all,’” explained Rooney. “Our results signal that some people with prediabetes have a higher risk of progressing to type 2 diabetes. These are the patients who may benefit from more targeted, intensive treatment than others.”

Beyond Medication: Lifestyle and the Cardiovascular-Kidney-Metabolic Framework

While the study highlights the potential for identifying high-risk individuals, it also reinforces the importance of established preventative measures. The American Heart Association emphasizes that lifestyle changes – including weight loss, a healthy diet, and regular physical activity – remain fundamental to reducing the risk of type 2 diabetes and managing its associated complications.

The findings also open a discussion about the potential role of GLP-1RA medications in preventing type 2 diabetes in prediabetic individuals who meet specific BMI and health criteria. However, Rooney cautioned that the cost-effectiveness of using these medications for prevention remains unknown. This is particularly relevant given the medications’ cost and the need to prioritize resources effectively.

Joshua J. Joseph, M.D., M.P.H., FAHA, ASCI, chair of the Lifestyle Diabetes Committee for the American Heart Association’s Council on Lifestyle and Cardiometabolic Health, noted the need for further research. “Different groups of people with type 2 diabetes may need different prevention strategies based on their level of risk,” he said. “A next step would be to study a larger and more diverse group of people so we can better understand how factors like where someone lives, their background and their community influence risk.”

Joseph further emphasized the importance of a proactive approach, aligning with the cardiovascular-kidney-metabolic syndrome framework, which prioritizes early intervention to address interconnected risk factors before they escalate into more serious conditions.

Study Details and Limitations

The study population consisted of 662 young adults with an average age of 32. The cohort was diverse, with 33% women, 47% identifying as Hispanic/Latino, 45% as non-Hispanic White, and 7% as non-Hispanic Black. Data collection occurred between 1985 and 2011, prior to the widespread availability of GLP-1RA medications for weight loss.

It’s important to note the study’s limitations. Researchers did not have access to hemoglobin A1c data, a blood test that provides a more comprehensive measure of average blood sugar levels over 2-3 months. The analysis relied solely on fasting glucose measurements. This means the study may have underestimated the true risk of progression to type 2 diabetes in some individuals.

What’s Next: Refining Prevention Strategies

The findings from this research contribute to a growing body of evidence suggesting that a more personalized approach to prediabetes management is warranted. Future research will likely focus on identifying additional risk factors and developing more refined prediction models to accurately assess an individual’s likelihood of developing type 2 diabetes. Further investigation into the cost-effectiveness and long-term benefits of GLP-1RA medications for prediabetes prevention is also needed. The goal is to move beyond a “one-size-fits-all” strategy and implement targeted interventions that effectively reduce the burden of type 2 diabetes in young adults.