Trends in Prevalence, Awareness, and Treatment of Diabetes and Prediabetes among Young Adults in the US, 1988-2020

Objective: To estimate trends in prevalence, awareness and treatment of diabetes and prediabetes among young adults in the US. Methods: Adults aged 20-44 years except pregnant women were included from the National Health and Nutrition Examination Survey between 1988-1994 and 2017-2020. Primary outcomes were diabetes and prediabetes defined according to self-reported diagnosis, fasting plasma glucose, or hemoglobin A1c. Secondary outcomes were awareness and treatment of diabetes and awareness of prediabetes. The prevalence trends of outcomes were assessed, and grouping variables (e.g., age, sex, race/ethnicity) were selected for subgroup analysis. Results: Among young adults included, the estimated prevalence of diabetes increased from 3.1% [95% CI, 2.5%-3.7%] in 1988-1994 to 4.9% [95% CI, 4.0%-5.8%] in 2017-2020 (P=0.002). The estimated prevalence of prediabetes rose from 21.8% [95% CI, 19.7%-23.9%] in 1988-1994 to 28.7% [95% CI, 24.6%-32.8%] in 2017-2020 (P=0.001). The estimated prevalence of diabetes awareness decreased from 70.8% [95% CI, 60.4%-81.2%] in 1988-1994 to 64.9% [95% CI, 59.0%-70.8%] in 2010-2020 with no significance (P=0.25), and the estimated prevalence of diabetes treatment plateaued (P=0.64). In 2011-2020, among young adults with prediabetes, only 8.8% [95% CI, 6.5%-11.2%] reported being aware of their condition. During the study period, young adults aged 20-29 years had significant decrease in the prevalence of diabetes awareness and diabetes treatment, significant increase in the prevalence of prediabetes, and the lowest prevalence of prediabetes awareness. Conclusions: Among young US adults, the estimated prevalence of diabetes and prediabetes increased significantly from 1988 to 2020, and their awareness of diabetes and prediabetes was insufficient, especially among adults aged 20-29 years. Comprehensive actions are needed to address the continuously rising burden of glycemic control among young adults in the US. Disclosure Y.Huang: None. H.Wang: None. V.W.Zhong: None. Funding Shanghai Municipal Education Commission (QD2020027, GWV-10.1-XK15)