Prediabetes Study Flags One Particular Group for Increased Mortality Risk

 

• Previous research on associations between prediabetes and mortality has produced conflicting results.
• This study found that prediabetes was statistically significantly associated with mortality only among adults ages 20 to 54 years.
• Mortality risk in younger adults could be due to metabolic or behavioral risk factors.

Prediabetes was associated with an increase in mortality among younger adults, according to a cohort study.

Using data for over 38,000 participants in the National Health and Nutrition Examination Survey (NHANES), stratified models found that prediabetes was statistically significantly associated with mortality only among adults ages 20 to 54 years (HR 1.64, 95% CI 1.24-2.17), reported Leonard E. Egede, MD, MS, of the University at Buffalo, and colleagues in JAMA Network Openopens in a new tab or window.

"These findings underscore the need for tailored diabetes prevention programs targeting young adults -- such as flexible, virtual, and peer-led options -- to increase accessibility and engagement," the authors wrote. "Routine screening and timely referrals to age-appropriate programs are essential."

Co-author Obinna Ekwunife, PhD, also of the University at Buffalo, told MedPage Today that "clinicians should not dismiss prediabetes as benign, especially in younger, otherwise healthy adults. It represents a window of opportunity for prevention."

However, "the actual number of deaths was still very low," Ekwunife said. "While it is something to pay attention to as an early warning sign, it is not something to panic about."

Previous research on associations between prediabetes and mortality has produced conflicting results. A 2021 meta-analysisopens in a new tab or window linked the condition to higher mortality, while a 2019 studyopens in a new tab or window found no link in older adults.

In the current study, prediabetes was initially associated with mortality (HR 1.58, 95% CI 1.43-1.74), but lost significance in the fully adjusted model (HR 1.04, 95% CI 0.92-1.18).

"Our goal was to clarify whether prediabetes independently raises mortality risk, and for whom, so that interventions can be better targeted," Ekwunife said.

He speculated that the mortality risk in younger adults might reflect "a marker for other metabolic or behavioral risk factors, such as insulin resistance, or poor cardiovascular health." He also said it could indicate "reduced access to care or a lower engagement in regular preventive care ... [which] may result in delayed diagnosis and treatment."

Elizabeth Selvin, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, who was not involved in the study, told MedPage Today that the findings were "very consistent with [the 2019 study] demonstrating that prediabetes in older adults is not strongly associated with mortality."

"Current definitions of prediabetes are very broad and they capture a lot of people who are not at high risk for poor outcomes, especially in old age," she said. "In older ages, mild elevations in glucose are extraordinarily common and seem to reflect mild metabolic dysfunction corresponding with aging rather than severe hyperglycemia that leads to diabetes."

For this study, Egede and colleagues used data for individuals who participated in NHANES survey cycles from 2005 to 2018. They included 38,093 respondents, 26.2% of whom had prediabetes, representing more than 51 million U.S. adults. Prediabetes was defined by self-report or hemoglobin A1c levels of 5.7% to 6.4%.

Of the total respondents, 65.1% were 20 to 54 years old, 51.9% were women, 66.7% were white, 11.4% were Black, and 21.9% were "other." The majority were married (55.1%) and non-smokers (55.2%), 31.8% had hypertension, and 6.9% had heart disease.

No significant associations were found among racial and ethnic groups.

In the group of participants ages 20 to 54, 2.9% with prediabetes died, as did 2.3% without prediabetes. Causes of death were not identified.

The researchers noted several limitations, including the study's cross-sectional and observational design, its potential self-report bias, lack of longitudinal tracking of participants, and inability to determine causes of death.

Disclosures

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. No other disclosures were reported.

Selvin disclosed funding from the NIH and the American Heart Association. She is a deputy editor at Diabetes Care.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowEkwunife O, et al "Demographics, lifestyle, comorbidities, prediabetes, and mortality" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.26219.

https://www.medpagetoday.com/primarycare/diabetes/116906