Pediatric Diabetes & Endocrinology

Taking Action for Adolescents with Prediabetes: Lifestyle Interventions

    In 2022, a report published in JAMA Pediatrics found that nearly one in three adolescents now meet the criteria for prediabetes and the rate among 12- to 19-year-olds had more than doubled from 11% to 28% between 1999 and 2018. “This was very concerning,” says Marisa A. Censani, MD, Director of the Pediatric Obesity Program at NewYork-Presbyterian/Weill Cornell Medicine. “Pediatric patients with obesity are at higher risk for several medical conditions, such as metabolic syndrome, insulin resistance, high blood pressure, and hyperlipidemia. Importantly, prediabetes is shown to track from adolescence into adulthood.”

    According to the American Diabetes Association, a healthy diet and physical activity are modifiable risk factors shown to reduce prediabetes risk. With this in mind, Dr. Censani, Tashara M. Leak, PhD, RD, an Associate Professor in the Division of Nutritional Sciences at Cornell University, and their colleagues undertook a study to examine associations between diet and physical activity by prediabetes status among adolescents 12 to 19 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2018.

    “We wanted to look at this patient population with prediabetes, in particular, as compared to adolescents who have not developed prediabetes,” says Dr. Censani. “We know that a healthy diet can reduce the risk for developing diabetes. One way to measure the diet quality is through the Healthy Eating Index score – a measure of the adherence to the dietary guidelines recommended for Americans.”

    When the research team analyzed the data of 2,487 adolescents, 72.8% did not have prediabetes and 27.2% had prediabetes. They found that adolescents with prediabetes had lower total Healthy Eating Index scores and a lower intake of important nutrients. Specifically, the study, published in Childhood Obesity, revealed:

    • Adolescents who were male (vs. female) with obesity (vs. normal weight) were more likely to have prediabetes
    • Significantly lower whole-grains component scores for the prediabetes group
    • Lower intakes of vitamin D, phosphorus, and potassium, as well as vitamin B6 and choline for the prediabetes group
    • Added sugar intake did not vary by prediabetes status
    • Suboptimal physical activity levels for both groups

    “These results indicated to us that we needed lifestyle interventions to target adolescents with prediabetes that provide them with a healthy eating goal and optimize their physical activity,” notes Dr. Censani. “Families need education on ways to incorporate whole grains and fresh foods with fiber in their diets. Adding foods that lower the glycemic index to promote more stable blood sugar levels is key. As physicians, we play an important role in advancing initiatives to help support healthier outcomes for children and their families. We are particularly well-positioned to discuss diet and nutrition and exercise in our clinical practices. Our study highlights the importance of having these conversations early on.”

    Black Girls for Wellness Program

    “The preliminary data from our study indicated that future research is needed to explore the mechanisms for which diet and physical activity affect prediabetes status among adolescents and provided a basis for future interventions,” says Dr. Censani. “That is indeed what we're doing with our current study.”

    With their findings from the study as a stepping stone, Dr. Censani in collaboration with Dr. Leak initiated a pilot project – Black Girls for Wellness Program – to examine the value of a culturally tailored telehealth lifestyle intervention for Black adolescent girls with obesity who are at risk for type 2 diabetes. The program, which is funded in part by the NIH National Institute on Minority Health and Health Disparities R21 exploratory/developmental grant, seeks to characterize how changes in diet and physical activity specifically affect clinical outcomes.

    “We know that Black youth have a significantly higher incidence of type 2 diabetes than other populations, and girls have a higher prevalence than boys,” says Dr. Censani. “We also know that diet and physical activity can be addressed to lower risk for type 2 diabetes.”

    The Black Girls for Wellness Program is enrolling Black adolescent girls who have a body mass index >95th percentile, as well as a female caregiver, for example, mother, grandmother, or aunt, who lives in the same home. “We are advocating mother-daughter dyads,” adds Dr. Censani. “The mothers and daughters are doing this program together. The next stage of the study is to transition the Black Girls for Wellness to an in-person program.”

    In the 12-week program, 12- to 18-year-old participants engage in a weekly virtual wellness session focusing on mindfulness, nutrition, and physical activity. Specifically, the intervention consists of:

    • Girl Chat, including meditation and group discussion on topics relevant to Black girls and women
    • Dance class, highlighting dances from the African diaspora
    • Interactive nutrition lesson
    • Participants prepare an ethnic dish at home with their family with groceries and recipes provided in advance by the program
    • Closing, including a survey about the weekly sessions

    “Our overall aim is to address diet quality, increase physical activity, and improve glycemic measures,” says Dr. Censani. “Almost every pediatric health problem is impacted by the co-existence of obesity,” adds Dr. Censani. “Parental obesity risks are so striking. Having one parent with obesity confers a three-fold risk and two parents confer a 10-fold risk of obesity into adulthood. It’s important for us to identify children with prediabetes, assess the medical complications of childhood obesity, and work with the families to incorporate healthier options to prevent the deficiencies that we saw clearly in our study. If we can diagnose and intervene early on, we can help to give our patients a healthy future.”

      Learn More

      Leak TM, Overcash F, Reicks M, Leung CW, Barr-Anderson DJ, Censani M. Diet and Physical Activity by Prediabetes Status Among U.S. Adolescents: National Health and Nutrition Examination Survey, 2007–2018. Childhood obesity. Published online February 12, 2024. doi:10.1089/chi.2023.0110

      For more information

      Dr. Marisa Censani
      Dr. Marisa Censani
      [email protected]