Prediabetes in youths: mechanisms and biomarkers

Obesity has been estimated to decrease life expectancy by as little as 0·8 years to as much as 7 years, and is the second leading cause of preventable death—after smoking—in the USA. Alongside the increase in the prevalence of obesity, prediabetes and type 2 diabetes have become more common in adolescents. Yet, little is known about the pathogenesis of these conditions in the paediatric population and how prediabetes could be detected at an early stage to prevent progression towards overt diabetes. In this Review, we summarise knowledge on the pathophysiology of prediabetes and type 2 diabetes in adolescents, and describe how biomarkers of β-cell function might help to identify individuals at risk of progression from normal glucose tolerance towards prediabetes and overt type 2 diabetes. To better understand and treat this disease, new therapeutic strategies will need to be explored and developed, and more sensitive and specific biomarkers are needed to allow earlier detection of prediabetes.