In the last decade, the incidence and prevalence of type 2 diabetes in the U.S. adolescent population has increased. And now with the rise in prediabetes among adolescents and young adults, it is important for physicians to advance the conversation. Learn what physicians should be doing to address prediabetes in teens and young adults.
About one in five teenagers and one in four young adults have prediabetes, according to a study in JAMA Pediatrics. This puts adolescents and young adults at an increased risk for type 2 diabetes and cardiovascular disease.
While pediatricians often diagnose children with obesity and prediabetes, many do not include physical activity assessment, counseling or prescription in the treatment plan, despite strong evidence showing that physical activity can improve body composition, decrease cardiovascular disease risk and is a preferred treatment for prediabetes.
With the rise in prediabetes among adolescents and young adults, Kate Kirley, MD, a family physician and director of chronic disease prevention at the AMA, explains what doctors should be doing.
Screen for prediabetes
Physicians might not routinely screen for risk in younger patients. However, the increase in prediabetes among teens signals a need to screen earlier.
“It is disheartening, but perhaps not surprising, given that we know trends in adolescent and young adults with overweight and obesity have been increasing,” said Dr. Kirley. “It means that those of us who care for adolescents and young adults need to be aware of this and the fact that even our young patients can have elevated risk for developing type 2 diabetes in the relatively near future.”
The American Diabetes Association recommends that physicians screen for prediabetes and type 2 diabetes for children 10 or older who are overweight or have obesity and have one or more diabetes risk factors, explained Dr. Kirley.
Set goals for healthy change
Physicians should share with the patient and their family the increased risk of developing type 2 diabetes. Beyond that, the key is to work together to set goals around healthy lifestyles.
“Many of these adolescents have overweight and obesity. Unfortunately, that area is also very frustrating in terms of not having a lot of effective interventions,” said Dr. Kirley. “There is some evidence that intensive lifestyle-change interventions can have a more modest but good impact on weight. That’s definitely something to consider for a lot of these adolescents.”
This includes what patients can do to improve their diet and physical activity. For example, encourage younger kids, as well as teenagers, to be physically active. Ideally, kids and teenagers—as well as young adults—should sit less and move more.
Try to aim for a “minimum of 20 minutes of activity a day, but shoot for 60 minutes of activity a day,” said Dr. Kirley.
Learn more from the AMA about how patients can start—and stick with—key lifestyle changes.
Encourage creativity to remain active
"Throughout the COVID-19 pandemic, stay-at-home orders have caused children, adolescents and young adults to lose several of their regular sources of physical activity,” said Dr. Kirley. This includes physical education at school, recess, playing with friends and organized sports.
Additionally, children may not have access to the physical spaces where they can easily get physical activity, such as parks or playgrounds.
“It takes a lot of creativity on the part of the family right now to find fun ways that kids can be active on their own or with siblings, parents or other members of their household in the spaces that they have safe access to,” she said.
Include the patient’s family
“If you’re going to work on healthy lifestyles, you don’t want to work on just the teenager. You’ve got to be talking to and working with the whole family,” said Dr. Kirley. “You have to recognize that adolescents only control some of their environment. A lot of it they don’t control, so you really need parental involvement and support there.”
For example, if a teenager is working on creating a healthy lifestyle, but the rest of the family is not doing the same, it can be hard to make those changes stick. Get the family involved for better results.
While teens are not permitted to join a diabetes prevention program, young adults can. Once a patient turns 18, they are eligible to participate.
“There’s a fair amount of research underway now at the CDC [Centers for Disease Control and Prevention] and through other organizations, because this is a major gap in terms of having interventions for this age group,” said Dr. Kirley.
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.