Once considered adult-onset conditions, Type 2 diabetes and prediabetes are now increasingly showing up in children and teens, a trend that has doctors, public health experts, and parents concerned. Over the past two decades, prediabetes rates among U.S. adolescents have more than doubled. Now, a recent estimate from the Centers for Disease Control and Prevention suggests that roughly 1-in-3 teens in the U.S. had prediabetes in 2023—a figure that mirrors the prevalence among adults. While some experts have raised questions about how prediabetes is defined and measured in youth, there is broad agreement that the condition is becoming increasingly common among adolescents.
“The fact that we’re seeing this in children is concerning,” says Anna Herby, DHSc, RD, CBDCE, who serves as a diabetes nutrition education specialist for the Physicians Committee for Responsible Medicine. Even when it doesn’t progress to Type 2 diabetes, prediabetes increases the risk of cardiovascular disease by 15% and doubles the likelihood of developing chronic kidney disease.
The good news? Herby says prediabetes is reversible, in some cases even in a matter of weeks. But that reset requires buy-in from both parents and the teens, and it starts with diet, Herby explains. Read on to explore more about this condition and the best foods to help your teen treat and reverse prediabetes.
What Causes Prediabetes?
“Insulin’s job is to open the cell doors and allow sugar into your cells, and that’s a good thing, because we’re built to run off of sugar and carbohydrates,” Herby explains. “But when you have prediabetes, you’re starting the process of insulin resistance.”
Insulin resistance occurs when cells stop responding properly to insulin’s signals to absorb glucose (blood sugar) from the bloodstream. The pancreas tries to compensate by releasing more insulin. But over time, those efforts can wear out the system, increasing the risk of Type 2 diabetes.
Many people believe carbs are the culprit, but that’s a common misconception. “People think you’re eating too many carbs, and your insulin just gets tired. That’s not the case.” Instead, she says, fats get stuck within muscle cells. “If you think of insulin like a key, then [fat is] bubble gum in the lock. So, insulin is trying to send a message to open the doors and allow sugar into the cell, but it’s not going through, or it’s going through less.”
When less sugar reaches a person’s cells, more remains in the bloodstream. This raises fasting blood sugar above the normal threshold (100 mg/dL) and, with time, potentially into the diabetic range (126 mg/dL or higher).
Why Teens Today Are at Greater Risk
Type 2 diabetes diagnoses among youth nearly doubled between 2002–2003 and 2017–2018. If this trend continues, the number of youths with Type 2 diabetes could rise from 28,000 cases in 2017 to 220,000 by 2060.
What’s behind the surge? There are likely myriad contributing factors, which include the following:
- Rising obesity rates: Obesity increases the risk of developing Type 2 diabetes by at least six times, according to a 2020 study published in Diabetology. About 22% of U.S. adolescents are obese.
- Physical inactivity: Physical activity has been shown to improve insulin sensitivity. Globally, only 20% of adolescents engage in the 60 minutes of physical activity the World Health Organization recommends each day for their age group, while more than half of U.S. adolescents spend more than four hours a day on recreational screen time, such as watching TV, scrolling through social media, or playing video games.
- Ultraprocessed diets: Also known as highly processed foods, ultraprocessed foods are typically high in added sugar and fat. Research published in JAMA in 2021 revealed that more than two-thirds of the calories consumed by teens come from these types of foods, particularly ready-to-eat meals, sweet snacks, and desserts.
How Food Choices Affect Insulin Resistance
Many ultraprocessed foods are also rich in animal-based ingredients, which research suggests may contribute to the development of insulin resistance. A 2017 study published in Current Developments in Nutrition found that higher consumption of animal protein was linked to increased insulin resistance. In contrast, plant protein from sources such as whole grains, legumes, and nuts was associated with improved insulin sensitivity.
Consuming animal protein increases the release of a hormone called glucagon from the pancreas. While insulin lowers blood sugar by helping cells absorb glucose, glucagon raises blood sugar by signaling the liver to release stored glucose into the bloodstream. Over time, this pattern can make cells less responsive to insulin’s signals and increase the risk of kidney damage and cardiovascular disease. Plant protein, on the other hand, contributes to kidney and cardiovascular health.
“So we’re thinking if kids are eating an egg, cheese, and sausage sandwich for breakfast … then drinking a glass of milk or maybe eating French fries—all that fat adds up throughout the day and your body doesn’t get a chance to recover because by the time you’re processed the fat from the first meal, you’re onto the next meal,” Herby says. “And so that’s the main thing: the fat in your diet. [Eating] animal products, too much fat, and processed foods that contain a lot of oils [will make] insulin resistance worse.”
The Best Foods to Eat to Reverse Prediabetes
To reverse prediabetes, Herby recommends that families:
- Remove animal products from the diet. “You can’t really follow a low-fat diet and also eat animal products,” Herby says. “Even chicken, which we think of as a healthier [meat] option, still has a significant amount of fat and cholesterol in it.”
- Avoid fried foods and added oils. Sauté in water or low-sodium vegetable broth instead.
- Embrace whole or minimally refined plant-based foods such as beans, fruits, vegetables, oats, lentils, brown rice, or whole wheat pasta.
Beans, in particular, are a standout food when it comes to blood sugar management. “I don’t think that kids are eating enough beans or have an appreciation for how great they are,” says Herby. “They’re one of the most powerful foods for blood sugar because not only are they low in fat, but they’ll provide protein and fiber.”
Simple, Kid-Friendly Ways to Eat Healthier
If a full pantry overhaul feels overwhelming, Herby recommends starting small. “Just start adding in healthier options like bean burritos, smoothies, and oatmeal, and have healthy snacks available. Then, slowly get things out of the house that are not good options.”
Emphasizing addition rather than subtraction can make the transition smoother and more sustainable. “Start with the diet,” Herby says. “That’s the most important thing.”
Children who have a family history of Type 2 diabetes or have signs of insulin resistance should be screened every two years starting at age 10, according to the American Diabetes Association.
To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.
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