Research presented at the American Heart Association's EPI|Lifestyle Scientific Sessions 2026 indicates that the risk of progressing from prediabetes to Type 2 diabetes varies substantially among young adults, with those having high fasting glucose levels and additional risk factors facing the greatest threat. The findings suggest current prevention strategies may need to become more targeted to address this growing health concern among adults under 40.
The analysis of 662 young adults with prediabetes found an overall 5-year progression risk of 7.5%. However, this risk increased to 10.9% for individuals meeting criteria for treatment with GLP-1 Receptor Agonist (GLP-1RA) medications for weight loss. Those with higher fasting glucose levels (110-125 mg/dL) faced a 15.1% risk, while those combining both higher glucose levels and GLP-1RA eligibility criteria showed a 24.8% risk of developing Type 2 diabetes within five years.
"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 Mary Rooney, Ph.D., M.P.H., lead author of the study and an assistant research professor at Johns Hopkins Bloomberg School of Public Health.
The study raises important questions about prevention strategies as Type 2 diabetes and prediabetes diagnoses continue rising among adults 40 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 weight loss, healthy eating, and regular physical activity may reduce progression from prediabetes to Type 2 diabetes and help manage related risk factors.
The research also suggests GLP-1RA medications might benefit certain high-risk prediabetes patients, though their cost-effectiveness for diabetes prevention remains unknown. Eligibility for these medications typically requires obesity (BMI ≥30) or overweight (BMI ≥27) plus conditions like high blood pressure or high cholesterol. While FDA-approved for Type 2 diabetes treatment and weight management, these medications are not approved for prediabetes prevention.
"Different groups of people with Type 2 diabetes may need different prevention strategies based on their level of risk," said Joshua J. Joseph, M.D., M.P.H., an American Heart Association volunteer expert. "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."
The study analyzed data from three U.S. studies conducted between 1985 and 2011, prior to GLP-1RA medication approvals. Participants averaged 32 years old, with 33% women and diverse racial/ethnic representation. Researchers acknowledge limitations, including the absence of hemoglobin A1c measurements, which provide additional prediabetes assessment beyond fasting glucose tests.
As noted in the American Heart Association's health information about prediabetes, early intervention remains crucial. The organization's comprehensive management guidelines for cardiovascular risk factors in adults with Type 2 diabetes emphasize integrated approaches to prevention and treatment. Additional resources on heart disease risk and prevention are available through the Association's educational materials.
