Prediabetes, once thought to be primarily an adult condition is now emerging as a major pediatric health concern, particularly among children with overweight or obesity. Recent research published in the International Journal of Obesity reveals a striking increase in the prevalence of prediabetes among young people with obesity in Finland, independent of changes in overall obesity rates, pointing to deeper metabolic shifts that extend beyond weight alone.

      Study Overview Researchers analysed data from two well-characterised cohorts of Finnish children aged 6–16 years:

• 602 pediatric patients with overweight or obesity attending healthcare between 2002 and 2020.
• 483 population-representative control children without clinical overweight/obesity.

      Prediabetes was defined using standard fasting and 2-hour oral glucose tolerance criteria, and diabetes was categorised according to conventional glucose thresholds. The investigators examined temporal trends over nearly two decades, adjusting for demographic and clinical factors.

      Key Findings

      The prevalence of glucose disturbances in this cohort was alarming:

• Among children with overweight/obesity, 34.2% had prediabetes and 1.3% had type 2 diabetes, compared with 6.9% prediabetes and 0% diabetes in controls.
• The likelihood of prediabetes or type 2 diabetes increased with age and pubertal stage, underscoring the role of developmental and hormonal factors.
• Most strikingly, the prevalence of prediabetes climbed steeply over time, rising from about 11.4% in 2002–2004 to approximately 50% in 2017–2019 among children examined in routine obesity-related healthcare. This increase occurred without concurrent rises in the degree of obesity or other metabolic disorders, suggesting additional drivers beyond adiposity.

      Other cardiometabolic risk factors, such as elevated insulin resistance (HOMA-IR), triglycerides, ALT (liver enzyme), and the presence of acanthosis nigricans and metabolic dysfunction-associated steatotic liver disease (MASLD), were also more common in children with prediabetes/type 2 diabetes than in their normoglycemic peers.

      Clinical Insights
The rapid rise in prediabetes among children with obesity signals a troubling shift in pediatric metabolic health. Importantly:

• The increase in prediabetes prevalence occurred independent of changes in obesity severity, suggesting that factors beyond body mass such as maternal overweight, early-life exposures, dietary patterns, physical inactivity, and liver fat accumulation may play crucial roles.
• The strong association between prediabetes and markers of metabolic dysfunction (e.g., acanthosis nigricans and MASLD) highlights the interwoven nature of glucose regulation, liver health, and cardiometabolic risk in children.
• Early puberty appears to be a vulnerable window, as the prevalence of glucose dysregulation rose with age and pubertal stage.

      These patterns show that disturbances in glucose metabolism are no longer confined to adults and that pediatric prediabetes may be evolving rapidly into a critical public health challenge.

      Public Health Implications

      The findings raise important considerations for clinicians, caregivers and policy-makers:

• Routine screening for glucose abnormalities should be considered in children with overweight or obesity, especially as they advance through puberty.
• Interventions must go beyond weight reduction alone, incorporating dietary quality, physical activity, sleep, and liver health assessments.
• The rising prevalence of prediabetes among children demands population-level action including early education, prevention programmes, and family-centred lifestyle strategies to interrupt progression toward type 2 diabetes and associated complications.

      GEMS Take Away
Prediabetes is no longer rare in children with obesity. Its rapid increase over the past two decades even without changes in overall obesity severity underscores an urgent need for early identification, comprehensive cardiometabolic risk screening, and preventive strategies that address liver health, insulin resistance and lifestyle factors from a young age.