Prediabetes in children and adolescents: what do we need to know?

Pediatric obesity is a growing global concern because it leads to an increased prevalence of abnormal glucose metabolism, including dysglycemia, prediabetes, and type 2 diabetes. Those conditions are associated with significant cardiovascular risk factors such as dyslipidemia, hypertension, metabolic dysfunction–associated steatotic liver disease, and sleep disturbances. Insulin resistance is a key contributor to the pathophysiology of those conditions, and the physiological reduction in insulin sensitivity during puberty further contributes to their pathogenesis in youth. However, insulin sensitivity improves after puberty, leading to spontaneous normalization of glucose metabolism in most individuals and complicating the concept of prediabetes. Therefore, general population screening for diabetes in youth is not recommended except in certain populations with high prevalence. When prediabetes is identified, lifestyle modification remains the primary intervention because pharmacologic treatments have yet to show efficacy in youth. This review explores the definitions, risk factors, screening recommendations, and management strategies for prediabetes in children and adolescents and highlights the limitations of applying adult-based diagnostic criteria to the pediatric population.