Young adults with prediabetes who have elevated fasting glucose levels combined with obesity or related health conditions face dramatically higher risk of developing Type 2 diabetes within five years, according to preliminary research presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026. The findings suggest current prevention approaches may need to become more targeted to address varying risk levels among this growing population.
The study analyzed 662 adults ages 18-40 with prediabetes from three U.S.-based studies: the Hispanic Community Health Study/Study of Latinos, the Coronary Artery Risk Development in Young Adults study and the Framingham Heart Study Third Generation. Participants were followed for an average of seven years, with health measurements taken between 1985 and 2011, before GLP-1 receptor agonist medications were approved for weight loss.
While the overall five-year risk of progressing from prediabetes to Type 2 diabetes was 7.5%, that risk increased substantially for specific subgroups. Individuals who met current criteria for treatment with GLP-1RA medications for weight loss—those with obesity or overweight plus at least one related condition like high blood pressure or high cholesterol—had a 10.9% risk. For those with higher fasting glucose levels (110-125 mg/dL), the risk grew to 15.1%, and for those with both high fasting glucose and eligibility for GLP-1RA treatment, the five-year risk reached 24.8%.
"Current approaches to Type 2 diabetes prevention are 'one-size-fits-all.' Our results signal that some people with prediabetes have a higher risk of progressing to Type 2 diabetes. These are the patients who may benefit from more targeted, intensive treatment than others," said lead author Mary Rooney, Ph.D., M.P.H., an assistant research professor at Johns Hopkins Bloomberg School of Public Health.
The research comes as diagnoses of Type 2 diabetes and prediabetes continue rising in adults 40 years old and younger. Complications from Type 2 diabetes include heart disease, kidney disease, stroke, and nerve damage affecting the brain, eyes, and feet. According to the American Heart Association, lifestyle changes such as losing weight, eating healthy, and regular physical activity may reduce progression from prediabetes to Type 2 diabetes and help manage related risk factors. More information about prediabetes is available at https://www.heart.org/en/health-topics/diabetes/about-diabetes/prediabetes.
The study raises the possibility that GLP-1RA medications, while not FDA-approved for preventing Type 2 diabetes in people with prediabetes, might benefit those at highest risk. "However, the cost-effectiveness of GLP-1 RA medications for Type 2 diabetes prevention, particularly in subgroups with the highest risk for Type 2 diabetes, is not yet known," Rooney noted.
American Heart Association volunteer expert Joshua J. Joseph, M.D., M.P.H., who was not involved in the study, emphasized the importance of early intervention. "Different groups of people with Type 2 diabetes may need different prevention strategies based on their level of risk. These findings support the idea of acting early, before Type 2 diabetes and related heart or kidney conditions become more serious, using healthy lifestyle changes and, when needed, medications to lower risk," said Joseph, who chairs the Association's Lifestyle Diabetes Committee.
The study has limitations, including the absence of hemoglobin A1c measurements, which provide another method for defining prediabetes, and reliance only on fasting glucose tests. The findings are considered preliminary until published in a peer-reviewed journal. Additional Association resources on related topics include a scientific statement on comprehensive management of cardiovascular risk factors for adults with Type 2 diabetes available at https://www.ahajournals.org/doi/10.1161/CIR.0000000000001040.
As researchers call for studies in larger, more diverse populations to better understand how factors like location, background, and community influence risk, these findings highlight the need for more nuanced approaches to prediabetes management in young adults, potentially combining intensive lifestyle interventions with consideration of medication for those at highest risk.
