1-in-3 U.S. Teens Now Has Diabetes or Prediabetes, Survey of 1,998 Finds

Nearly one in three American adolescents now lives with diabetes or prediabetes, according to a cross-sectional analysis of 1,998 young people aged 10 to 19 drawn from the National Health and Nutrition Examination Survey (NHANES) covering 2021 to 2023. The figure represents a striking burden of metabolic disease among a population group not typically associated with conditions once classified as adult-onset illness.

Among the 1,998 adolescents surveyed, approximately 28% met criteria for prediabetes - defined by fasting glucose or hemoglobin A1c values in the at-risk range - while a smaller subset had confirmed type 2 diabetes. The prevalence figure aligns with, and in some cases exceeds, estimates from earlier NHANES cycles, suggesting the problem has not improved despite decades of public health messaging about diet and physical activity.

Waist-to-Height Ratio Outperforms BMI as a Predictor

Of all clinical measures examined, waist-to-height ratio emerged as the strongest independent predictor of prediabetes and diabetes status among adolescents. That finding carries practical weight. Unlike body mass index, which requires age- and sex-adjusted growth charts to interpret in children, waist-to-height ratio is a simple calculation - waist circumference divided by height - that does not shift with a child's developmental stage. A value above 0.5 is generally considered a flag for cardiometabolic risk.

The prominence of waist-to-height ratio over BMI suggests that central adiposity - fat distributed around the abdomen and organs rather than overall body mass - may be a more clinically relevant marker in young people than the metric most commonly used in pediatric practice. This has implications for how routine screening is structured in primary care settings.

What the NHANES Design Can and Cannot Tell Us

The study used a nationally representative, cross-sectional design, meaning all measurements were taken at a single point in time. That approach captures prevalence accurately but cannot establish whether waist-to-height ratio causes metabolic dysfunction or simply correlates with it. Adolescents in the sample ranged widely in pubertal stage, ethnicity, socioeconomic background, and physical activity levels - variables that interact with metabolic risk in complex ways that a single survey cycle cannot fully untangle.

NHANES relies partly on self-reported dietary data alongside objective laboratory measures, and under-reporting of caloric intake in adolescents is well-documented. The 2021 to 2023 window also overlapped with the COVID-19 pandemic recovery period, during which physical activity patterns and food access changed substantially for many young Americans. Whether the prevalence figures reflect a pandemic-era anomaly or a durable trend requires follow-up cycles to determine.

Race, Ethnicity, and Socioeconomic Patterns

NHANES data consistently show that the burden of metabolic disease in adolescents is not evenly distributed. Hispanic and non-Hispanic Black youth, as well as those from lower-income households, show higher rates of obesity-related conditions. These disparities reflect structural factors including neighborhood food environments, access to safe spaces for physical activity, household stress, and differential access to preventive healthcare - factors that lie beyond any individual's immediate control.

Addressing the one-in-three figure will require more than screening more children for diabetes. It requires attention to the conditions that shape metabolic health long before a clinical visit occurs.

The Clinical Stakes of Adolescent Prediabetes

Prediabetes in adults carries a roughly 5 to 10% annual risk of progression to type 2 diabetes in the absence of intervention. In adolescents, that trajectory may be compressed. Studies have shown that type 2 diabetes progressing from prediabetes during adolescence is often more aggressive than its adult-onset counterpart, with faster loss of insulin-producing beta cell function and higher rates of complications including kidney disease, hypertension, and cardiovascular disease at younger ages.

Interventions proven effective in adults - structured lifestyle programs emphasizing dietary change and moderate physical activity - show benefit in adolescents as well, though adherence is typically lower, and family and school environments play a larger role in whether behavior change is sustained.

The findings reinforce the case for incorporating simple anthropometric measures, including waist circumference, into routine adolescent well-child visits. For a condition this prevalent in the 10-to-19 age group, catching it early - before it progresses to type 2 diabetes with its attendant complications - is both clinically and economically sensible. The study authors were affiliated with institutions in the U.S. and Ghana, and no specific funding was received for this work.