Study: Link between prediabetes and mortality strongest for younger adults

BUFFALO, N.Y. – Prediabetes, when blood sugar is higher than normal but not high enough to be considered diabetes, is more life-threatening in people aged 20-54 than it is in older populations, according to a paper published Aug. 7 in JAMA Network Open.

Conflicting evidence about the association between prediabetes and mortality prompted the University at Buffalo researchers to do the study.

“The literature has been inconsistent, particularly when accounting for key modifying factors, such as age, race/ethnicity and comorbidities,” says first author Obinna Ekwunife, PhD, assistant professor of medicine in the Jacobs School of Medicine and Biomedical Sciences at UB. “We wanted to explore whether these factors influenced the association between prediabetes and mortality in a nationally representative U.S. adult population.”

The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), the ongoing national survey run by the Centers for Disease Control and Prevention that measures the health and nutrition of children and adults.

The study consisted of data from 38,093 respondents, of whom 9,971 (26.2%) had prediabetes. Adults aged 20 and older were included. They were considered prediabetic if they self-reported that they were, or if their hemoglobin A1c, a three-month average of blood glucose levels, was between 5.7% and 6.4%.

The data showed a significant association between prediabetes and mortality before the researchers controlled for variations among demographics, lifestyle factors and comorbidities. But once they controlled for those factors, the association went away.

Significant link

“However, we found that the significant relationship between prediabetes and mortality was maintained after adjustment when the analysis focused on adults aged 20-54,” says Ekwunife.

He explains that it’s possible that older adults are more likely to have existing comorbidities so those chronic conditions may overshadow the impact of prediabetes.

“Another possibility is that prediabetes in younger adults might reflect a more detrimental disease trajectory with earlier onset of metabolic dysfunction,” he continues. Other possibilities for the association could be a stronger genetic predisposition, leading to more rapid disease progression, as well as health disparities, such as reduced access to care or lower engagement in regular, preventive care among younger populations.

Earlier screenings

Whatever the cause, Ekwunife says, the findings reflect the need to pay closer attention to early identification and intervention for prediabetes among younger adults.

“We may need to be doing A1C screenings earlier in younger people,” he says. “That would be particularly important for individuals with additional risk factors like obesity, a family history of diabetes, or socioeconomic disadvantages.”

The findings also underscore the importance of tailoring diabetes-prevention programs to be more accessible and appealing to younger populations, he notes, possibly incorporating things like virtual platforms, peer-led models, or more flexible engagement strategies like gamification or on-demand educational modules.

“Clinicians should recognize that early intervention could prevent both progression to diabetes and premature mortality,” he says, “and it gives patients an opportunity to make proactive lifestyle changes to prevent disease progression.”

The study’s senior author is Leonard E. Egede, MD, Charles and Mary Bauer Endowed Chair and professor of medicine in the Jacobs School. Other co-authors are Jennifer A. Campbell, PhD; Raphael Fraser, PhD; and Rebekah J. Walker, PhD; and Xuemeng Wang, data manager/statistician, all of the Division of Population Health in the Jacobs School, and David Jacobs, PharmD, PhD, in the UB School of Pharmacy and Pharmaceutical Sciences.

The work was funded by the National Institutes of Health.