UB study reveals stronger link between prediabetes and mortality in younger adults
Prediabetes poses a significantly higher risk of death for younger adults aged 20–54 than for older populations, according to new research from the University at Buffalo (UB) published this week in JAMA Network Open.
The study, led by Obinna Ekwunife, PhD, assistant professor of medicine at the Jacobs School of Medicine and Biomedical Sciences at UB, aimed to clarify conflicting evidence on the association between prediabetes and mortality.
“The literature has been inconsistent, particularly when accounting for key modifying factors such as age, race/ethnicity, and comorbidities,” Ekwunife said. “We wanted to explore whether these factors influenced the association between prediabetes and mortality in a nationally representative U.S. adult population.”
Key findings from the study
Researchers analyzed data from 38,093 adults in the National Health and Nutrition Examination Survey (NHANES), of which 9,971 (26.2%) had prediabetes. Participants were considered prediabetic if they self-reported the condition or had a hemoglobin A1c level between 5.7% and 6.4%.
Initial analysis found a significant link between prediabetes and mortality, but after adjusting for demographic differences, lifestyle habits, and comorbidities, the overall association disappeared — except in younger adults aged 20–54.
Ekwunife suggests that in older adults, pre-existing chronic conditions may overshadow the impact of prediabetes, while in younger adults it could indicate a more aggressive disease trajectory with earlier metabolic dysfunction. Genetic predisposition, faster disease progression, and disparities in healthcare access may also contribute to the increased risk.
Implications for early screening and prevention
Ekwunife emphasizes the importance of earlier screening for prediabetes, particularly in younger individuals with additional risk factors such as obesity, a family history of diabetes, or socioeconomic challenges.
“We may need to be doing A1C screenings earlier in younger people,” he said. “Clinicians should recognize that early intervention could prevent both progression to diabetes and premature mortality, giving patients a chance to make proactive lifestyle changes.”
The research team recommends adapting diabetes prevention programs to better engage younger populations, possibly through virtual health platforms, peer-led initiatives, gamification, and flexible educational tools.
Research team and funding
The study’s senior author is Leonard E. Egede, MD, Charles and Mary Bauer Endowed Chair and professor of medicine at UB. Other contributors include Jennifer A. Campbell, PhD; Raphael Fraser, PhD; Rebekah J. Walker, PhD; Xuemeng Wang, and David Jacobs, PharmD, PhD.
The work was funded by the National Institutes of Health (NIH).
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