Study Identifies High-Risk Prediabetes Subgroups in Young Adults, Suggesting Need for Targeted Prevention

Young adults with prediabetes who have high fasting glucose levels combined with additional risk factors such as obesity, high cholesterol, or high blood pressure face a substantially higher risk of developing Type 2 diabetes within five years, according to preliminary research presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026. The study suggests that current one-size-fits-all approaches to prediabetes management may miss opportunities for early, intensive intervention in those at highest risk.

The analysis of 662 adults aged 18-40 with prediabetes found that the overall five-year risk of progressing to Type 2 diabetes was 7.5%. However, this risk increased to 10.9% for individuals who met criteria for treatment with GLP-1 receptor agonist (GLP-1RA) medications for weight loss. Those with higher fasting glucose levels (110-125 mg/dL) faced a 15.1% risk, while individuals with both higher fasting glucose and eligibility for GLP-1RA treatment had a 24.8% risk of developing Type 2 diabetes within five years.

"Current approaches to Type 2 diabetes prevention are 'one-size-fits-all.' 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," said lead author Mary Rooney, Ph.D., M.P.H., an assistant research professor at the Johns Hopkins Bloomberg School of Public Health. The study used existing FDA criteria for GLP-1RA medication eligibility to estimate diabetes risk, though these medications are not currently approved for Type 2 diabetes prevention in people with prediabetes.

The research raises important questions about prevention strategies for different risk groups. According to the American Heart Association, lifestyle changes such as weight loss, healthy eating, and regular physical activity may reduce progression from prediabetes to Type 2 diabetes and help manage related risk factors. The study also suggests that GLP-1RA medications might benefit certain high-risk individuals with prediabetes, though their cost-effectiveness for diabetes prevention remains unknown.

"Different groups of people with Type 2 diabetes may need different prevention strategies based on their level of risk," said Joshua J. Joseph, M.D., M.P.H., an American Heart Association volunteer expert who was not involved in the study. "These findings support the idea of acting early, before Type 2 diabetes and related heart or kidney conditions become more serious, using healthy lifestyle changes and, when needed, medications to lower risk."

The study analyzed data from 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. Participants included adults with a mean age of 32 years, with 33% women, 47% identifying as Hispanic/Latino, 45% as non-Hispanic White, and 7% as non-Hispanic Black. Health information was collected between 1985 and 2011, before FDA approval of GLP-1RA medications for weight loss.

Researchers acknowledge limitations, including the absence of hemoglobin A1c measurements, which can also define prediabetes. Only fasting glucose tests were included in the analysis. The findings are considered preliminary until published in a peer-reviewed journal. The study's implications are significant given rising rates of Type 2 diabetes and prediabetes in adults under 40, and the serious complications associated with diabetes, including heart disease, kidney disease, and stroke.

For additional information about prediabetes and cardiovascular health, the American Heart Association provides resources at https://www.heart.org/en/health-topics/diabetes/about-diabetes/prediabetes. The organization's comprehensive approach to cardiovascular risk management is detailed in their scientific statement at https://www.ahajournals.org/doi/10.1161/CIR.0000000000001040.