Young Adults with Prediabetes Face Varying Diabetes Risks

Study finds those with high glucose levels and other risk factors have highest 5-year progression to Type 2 diabetes

Mar. 18, 2026 at 7:09am

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New research presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026 found that young adults with prediabetes face widely varying risks of progressing to Type 2 diabetes within 5 years. Those with high fasting glucose levels (110-125 mg/dL) and who met criteria for weight-loss medications had the highest 24.8% risk, compared to an overall 7.5% risk for the study group. The findings suggest a 'one-size-fits-all' approach to prediabetes may miss opportunities for more intensive, tailored prevention in high-risk individuals.

Why it matters

The study highlights the need for a more personalized approach to prediabetes treatment and prevention of Type 2 diabetes, especially in younger adults. Identifying those at highest risk could accelerate access to intensive lifestyle changes and, in some cases, weight-loss medications that may help delay or prevent progression to full-blown diabetes and its serious complications like heart disease, kidney disease and stroke.

The details

Researchers analyzed data on 662 young adults ages 18-40 (average age 32) with prediabetes, followed for about 7 years on average. They found the overall 5-year risk of progressing from prediabetes to Type 2 diabetes was 7.5%. However, the risk increased to 10.9% for those who met criteria for weight-loss medications like GLP-1 receptor agonists, and jumped to 15.1% for those with higher fasting glucose levels (110-125 mg/dL). For those with both higher glucose and medication criteria, the 5-year risk was 24.8%.

  • The study data was collected between 1985 and 2011, prior to FDA approval of GLP-1 receptor agonist medications for weight loss.
  • The findings were presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026 in Boston, March 17-20, 2026.

The players

Mary Rooney

Ph.D., M.P.H., lead author of the study and an assistant research professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Joshua J. Joseph

M.D., M.P.H., FAHA, ASCI, an American Heart Association volunteer expert and chair of the Lifestyle Diabetes Committee for the Association's Council on Lifestyle and Cardiometabolic Health, and an associate professor of internal medicine and the endowed professor for research in internal medicine at The Ohio State University Wexner Medical Center in Columbus, Ohio.

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What they’re saying

“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.”

— Mary Rooney, Ph.D., M.P.H., lead author (Mirage News)

“Different groups of people with Type 2 diabetes may need different prevention strategies based on their level of risk. 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, such as a rural or urban setting, their background and their community influence risk. 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, consistent with the cardiovascular-kidney-metabolic syndrome framework, which prioritizes early intervention.”

— Joshua J. Joseph, M.D., M.P.H., FAHA, ASCI (Mirage News)

What’s next

The cost-effectiveness of using GLP-1 receptor agonist medications for Type 2 diabetes prevention in high-risk prediabetes groups is still unknown and requires further study.

The takeaway

This research highlights the need to move beyond a one-size-fits-all approach to prediabetes and instead identify young adults at highest risk of progressing to Type 2 diabetes. Tailored, intensive interventions including lifestyle changes and potentially medications could help delay or prevent the development of diabetes and its serious complications in these high-risk individuals.