Kaiser Permanente study finds 2-fold higher prevalence compared to White adolescents and shows variations among Asian ethnic subgroups

Prediabetes is more than twice as common in Asian and Pacific Islander adolescents with overweight or obesity than it is in White youth with overweight or obesity, new Kaiser Permanente research shows.

The study, published in Diabetes Care, is among the first to look at rates of prediabetes in adolescent Asian and Pacific Islander subgroups.

“We found that prediabetes affected about 1 in 4 Asian and Pacific Islander adolescents with overweight or obesity,” said senior author Joan C. Lo, MD, a research scientist at the Kaiser Permanente Division of Research. “This has important public health implications, and it suggests that Asian and Pacific Islander adolescents with overweight or obesity should be considered a high-risk population for whom prediabetes screening is essential.”

The retrospective study included 38,191 members of Kaiser Permanente Northern California between ages 10 to 17 who were Asian, Pacific Islander, or White. The youth were included in the study because they met the criteria for overweight or obesity at a pediatric visit between 2012 and 2019 and had a hemoglobin A1c (HbA1c) blood test within a year of that visit. The HbA1c blood test is used to help diagnose type 2 diabetes and monitor blood sugar levels in people with diabetes.

The study found that, overall, 27% of the Asian and Pacific Islander youth had prediabetes compared to 12% of the White youth. When the researchers looked at specific Asian subgroups, they found prediabetes in 31% of South Asian youth, 32% of Native Hawaiian or Pacific Islander youth, 28% of Filipino youth, 26% of Chinese youth, and 18% of Vietnamese youth.

There are several reasons why prediabetes may be more common in Asian and Pacific Islander adolescents with overweight or obesity than in similar White adolescents, the researchers said. These include biologic and genetic traits associated with Asian, Native Hawaiian, and Pacific Islander ancestry, lifestyle and cultural factors, and social determinants of health.

“Our findings underscore the importance of screening for Asian and Pacific Islander youth with overweight or obesity because their prevalence of prediabetes is higher,” said first author Adrian Matias Bacong, PhD, MPH, a postdoctoral researcher for the Center for Asian Health Research and Education at the Stanford University School of Medicine. “But what happens after the screening takes place is what matters. The real value in screening is that it creates an opportunity for early and meaningful intervention for diabetes prevention.”

Currently, about 38.4 million U.S. adults have diabetes and another 97.6 million have prediabetes. Among youth ages 10 to 19, rates of type 2 diabetes nearly doubled from 9 cases in 2002-2003 to 18 cases per 100,000 youth in 2017-2018. This increase has occurred alongside, and is tied to, the childhood obesity epidemic.

Identifying youth with prediabetes creates an opportunity to intervene with educational and lifestyle information that can help reduce their risk of developing diabetes, a chronic condition that increases risk of heart and kidney disease, stroke, and high blood pressure.

For the study, body-mass index (BMI) percentiles were based on the Centers for Disease Control and Prevention growth chart. Youth with an HbA1c that ranged from 5.7% to 6.4% were classified in the prediabetes range. A neighborhood deprivation index was calculated based on area of residence and information from the U.S. Census on household income and poverty levels, education, occupation, and housing.

Previous studies have found that Asian adults are at higher risk of developing type 2 diabetes at a lower BMI than White adults. This is why diabetes screening is now recommended for Asian adults with a BMI of 23 or higher. For other racial and ethnic groups, a BMI of 25 is the threshold for diabetes screening. This study suggests that similar considerations may be relevant for adolescents.

“Our findings show why it is so important for researchers to not lump all adolescents or all Asians into one single category,” said Lo.

The U.S. Preventive Services Task Force currently does not recommend for or against screening for diabetes in adolescents. The American Diabetes Association recommends screening in adolescents from high-risk ethnic groups who have overweight or obesity. In Kaiser Permanente Northern California, diabetes screening is considered for adolescents with overweight or obesity, regardless of race or ethnicity.

“These results demonstrate how important it is for physicians to know about the higher rate of prediabetes in Asian and Pacific Islander youth and therefore the importance of doing prediabetes screening and lifestyle counselling in these youth at a lower BMI threshold,” said study co-author Louise Greenspan, MD, a pediatric endocrinologist with The Permanente Medical Group.

The study was funded by the Stanford Center for Asian Health Research and Education and the Cardiovascular, Kidney, and Metabolic Health Section of the Division of Research.

Co-authors include Veronica Njuguna, MD, of Kaiser Permanente Northern California; Jeanne Darbinian, MPH, Luis A. Rodriguez, PhD, MPH, and Erica P. Gunderson, PhD, MPH, of the Division of Research; and Nitya Rajeshuni, MD, MS, and Latha Palaniappan, MD, MS, of Stanford University.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit  or follow us @KPDOR.