Thirty-Year Glycemic Trajectories From Young Adulthood Through Middle Age
Abigail R O Arons1,2, Lucia Pacca3, David R Jacobs4
1Division of General Internal Medicine at Zuckerberg San Francisco General, Department of Medicine, University of California, San Francisco.
JAMA Network Open
|June 26, 2025
Summary
Glycemic trajectories vary significantly over 30 years. Impaired fasting glucose in young adults often doesn't progress to type 2 diabetes, suggesting new prevention strategies are needed.
Area of Science:
- Endocrinology
- Public Health
- Longitudinal Studies
Background:
- Increasing prevalence of type 2 diabetes and prediabetes in young adults.
- Limited understanding of glycemic changes from young adulthood to middle age.
Purpose of the Study:
- To examine glycemic trajectories from young adulthood through middle age.
- Identify common patterns of glucose regulation over three decades.
Main Methods:
- Utilized sequence analysis on 30-year fasting plasma glucose data from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
- Identified and clustered common glycemic trajectory patterns in a diverse cohort.
Main Results:
- Identified 9 common glycemic trajectory patterns among 3420 participants.
- Found that impaired fasting glucose (IFG) in young adulthood often did not progress to diabetes.
- Diabetes onset clusters typically lacked preceding IFG in young adulthood.
Conclusions:
- Glycemic trajectories exhibit significant heterogeneity over 30 years.
- Current screening for IFG in young adults may not effectively identify those at risk for future diabetes.
- Novel strategies are required for early identification and prevention of type 2 diabetes in young adults.
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