Young adults with prediabetes who have elevated fasting glucose levels and meet specific criteria for weight-loss medication treatment face substantially 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 that current one-size-fits-all approaches to prediabetes management may miss opportunities for early, intensive intervention in those at highest risk.
The analysis of 662 adults ages 18-40 with prediabetes found that while the overall 5-year risk of progression to Type 2 diabetes was 7.5%, this risk increased dramatically in specific subgroups. Individuals who met criteria for treatment with GLP-1 Receptor Agonist (GLP-1RA) medications for weight loss had a 10.9% risk. Those with higher fasting glucose levels (110-125 mg/dL) faced a 15.1% risk, and those with both high fasting glucose and eligibility for GLP-1RA medication treatment had 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 lead author Mary Rooney, Ph.D., M.P.H., an assistant research professor at the Johns Hopkins Bloomberg School of Public Health. The study used existing FDA criteria for prescribing GLP-1RA medications for weight loss, which include obesity or overweight plus at least one related condition such as high blood pressure or high cholesterol.
The research raises important questions about prevention strategies for the growing number of young adults diagnosed with prediabetes. According to the American Heart Association, lifestyle changes such as losing weight, eating healthy and engaging in regular physical activity may reduce progression to Type 2 diabetes and mitigate other risk factors. The Association provides comprehensive information about cardiovascular risk management at https://www.heart.org.
"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., FAHA, ASCI, 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." Joseph, who was not involved in the study, emphasized the importance of understanding how factors like geographic location and community background influence risk.
The study included participants 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 information collected between 1985 and 2011, all prior to FDA approval of GLP-1RA medications for weight loss. Researchers note that the findings are limited by the absence of hemoglobin A1c measurements, which provide additional information about blood sugar control over time.
While the study suggests GLP-1RA medications might help prevent progression to Type 2 diabetes in high-risk individuals with prediabetes, Rooney cautioned that "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." The research highlights the need for more personalized approaches to diabetes prevention, particularly as diagnoses of both prediabetes and Type 2 diabetes continue to rise among adults under 40.
