Ep. 102 Teen Prediabetes: Why "Keep an Eye on It" Is Riskier Than You Think

"He will grow out of it." "Let's just keep an eye on it." "He is a teenager, this is normal."

I hear these phrases from families all the time. And I completely understand why. Waiting feels reasonable. But when it comes to prediabetes in teenagers, the wait and see approach is not always the right one. And today I want to explain exactly why, using data from a major NIH research study that changed how I think about this.

Because here is the thing most parents and even many doctors do not realise. Prediabetes in a teenager is not the same condition as prediabetes in an adult. The biology is different. The progression is different. And the window to reverse it is real, but it is not unlimited.

I’m Dr. Jenny Gourgari—pediatric endocrinologist, certified in obesity medicine and a health coach. 
After helping hundreds of teens struggling with their weight and hormones, I’ve created a whole new path by doing what most programs miss: balance puberty hormones naturally and create habits that actually last.

Here's what makes this different:
✅ No dieting. No calorie counting. No shame.
✅ No more food fights between parents and teens.
✅ No weight obsession—just healthy habits
✅ Real science behind how puberty hormones affect weight
✅ A safe, supportive approach that prevents eating disorders

Because when teens understand their hormones and get the right support, they don’t just lose weight—they gain strength, energy, confidence, and freedom!

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Transcript

 Welcome to another episode of the Lifestyle and Weight Loss for Teens podcast. This is Dr. Jenny Gourgari, and on today's episode, I'll be talking about whether this, let's wait and see what happens approach is good or not, and when it becomes a problem. 

The other day, I had a child and his family come to me. They came to see me because the child was not growing anymore. This 17-year-old boy was done growing, and he was not happy with his height, and they said, "I wish we had more time." And unfortunately, once you're done growing, there's not much you can do about it. The clock has stopped. This wait-and-see approach, oftentimes, there are a lot of conditions in medicine where it's totally appropriate. But if your child has prediabetes, then this wait-and-watch approach may not always be the best. And today, I'm gonna explain three main reasons why the wait-and-watch approach is not always the best in children who have prediabetes. It's because there's been a research study that was done. So oftentimes people think that prediabetes in teenagers, insulin resistance in preteenagers, is the same thing as prediabetes in adults. The truth is, prediabetes in teenagers is very different than prediabetes in adults. There can be conditions that predispose both to diabetes, and diabetes does run in families through certain genes, but it's more than that. 

The three reasons I'm gonna explain today will give you a better understanding of what is going on, and it's not really that just a simple fact that your teen is lazy; there was this big NIH study. The RISE study, Restoring Insulin Secretion study. The researchers wanted to compare how does, prediabetes, look like between children and adults, and if they put them on treatment, do they have the same results and how do they progress over time? So they had a group of teenagers; they put them on insulin followed by metformin, or they just gave them metformin. Insulin and metformin are two common drugs that pediatric endocrinologists use to treat prediabetes. And then they also have a group of adults; they either give them nothing, or they give them metformin, or they give them insulin and metformin. They also have a surgical group, but that's a little different. The point is that they have a group of children and a group of adults. They followed them for about a year, and they gave them the same medications: insulin and metformin. And then they compared what happened to teenagers, what happened to adults. 

This study had some fascinating results. The first thing they found is that for the same amount of dysglycemia, the teenagers had to produce way more insulin to keep that sugar where it was. Let's say that a teenager eats a piece of pizza and the blood sugar after that piece of pizza is 180. Then the adult also eats the same amount of pizza. The sugar after that goes to 180. But when they look at the amount of insulin that the teenager had to produce to keep that sugar at 180, let's say, 200, and the adult was 100, to maintain the same amount of sugar, the teenage boys and girls had to produce significantly more insulin. 

Their bodies had to produce significantly more insulin, and that is one sign of insulin resistance. So a sugar of 100 in a teenager is not the same as the sugar of 100 in an adult. That's the first main take-home message. The second thing is what happens over time. The beta cells are the cells of the body that produce insulin. You produce insulin; the insulin keeps your sugar normal. What they found is that this function of those cells over time in teenagers was getting worse by 25 to 30% every year. But in adults, this decline in beta cell function was about 7% per year. So not only do the teenagers start at a worse position, but they also get worse over time. the degree of deterioration of those sick cells in the pancreas in teenagers is significantly higher, almost three times higher than that in adults. 

A third thing they discovered: after 12 months of treatment, they both got the same treatment, insulin and metformin; 17.8% of teenagers got worse despite the treatment. But in adults, 7.5% got worse. And when they followed them after 21 months, without any treatment, they found that 36% of teenagers had progressed versus 20% of adults. So, almost one in three teenagers versus one in five adults progressed and became worse over time, and that shows you again that teenagers with prediabetes, teenagers that have abnormal glucose, the progression is way more aggressive. 

The progression of the disease is more aggressive than the progression that we see in adults. Those numbers are fascinating. One in three teenagers versus one in five adults; the beta cell function was 30% worse every year in teenagers versus 7% in adults. Three to four times worse in teenagers. prediabetes is also reversible in teenagers. Like 25 to 50% of teenagers with prediabetes can get back to normal glycemia. But this is not gonna happen unless we do something about it. If we don't do anything about it, the problem is gonna get worse, and because this disease is worse in teenagers, they're more likely to develop type 2 diabetes. 

So what do we do about it? What the American Academy of Pediatrics and American Diabetes Association recommend is an approach that is personalized, and it covers not just eat less, move more. That's not gonna work in teenagers. It's a more personalized approach where you look at not only eating less, but what is it that you're actually eating. The quality of the food is very important. And exercise: move your body, and not only cardio, but do some strength exercise. Do things that improve insulin sensitivity, which gets worse by puberty. Sleep better. Have more fruits and vegetables. Address your stress level, because stress level leads to abnormal cortisol that can make your insulin resistance even worse. It's a multifactorial process, and we need to involve the whole family. teenagers that are successful are the teenagers whose family is involved. If you tell a teenager to have 100 calories and exercise one hour and bike, it's not gonna work. They need support. They need a minimum of 26 hours, ideally up to 50 hours, of support to get the results that they need. 

What does all this mean for your teenager? Time is very important. Teenagers progress from pre-diabetes to diabetes much faster than adults. Medications alone are not enough. I'm not saying medications are not needed. We need to give medications, and you should talk with your pediatric endocrinologist if your teenager has prediabetes. But it's not enough. We need lifestyle modifications. We need the right approach for these kids. The earlier we start, the better, because it's a progression. The earlier you tackle this, the lower your dysglycemia is, the easier it's gonna be to reverse it. The more you wait, the worse the dysglycemia, the less likely to reverse, the more likely to progress to diabetes. Another important message when it comes to teenagers that have prediabetes is that we need to drop that frame of, "Oh, he's lazy," or, "He doesn't care," or, "He's indifferent," or, That's why he has prediabetes." It's way more than that. It's a hormonal thing. It's a biological thing. And I'm not saying it is not important for teenagers to exercise. 

Absolutely, it's important for teenagers to exercise, important for teenagers to eat healthy. But it's not only that. Genetics plays a role, and insulin sensitivity during puberty plays a role, because for the same amount of effort, teenagers have the hit of puberty, which by itself it decreases insulin sensitivity by 30% just by being in puberty. Please be kind and compassionate to your teenagers if they're struggling with insulin resistance and prediabetes. It's not their fault. They need extra support, so we need food quality over food restriction. We need 60 minutes of daily fun activity. If it's not gonna be fun, then the teenagers are not gonna do it. 

Medication is part of the whole picture, but not the whole picture; all these medications need to work along with lifestyle modification. I know a lot of families are confused about what to look for, what the signs of insulin resistance and prediabetes are, and what they need to do. I have created a free guide. Go to lifestyleforteens.com, check free resources. 

There are three signs of insulin resistance, what to do when your teen is diagnosed with prediabetes. Download that. It's completely free. My main message today to you is: think again when you are wondering It's just the teenage years; he will grow out of it. You may not have the time. With prediabetes, you have time, but not endless time. You don't want to get to the point that you already have diabetes. You don't wanna get to the point that in early life you already have the complications of diabetes, because diabetes progresses faster. I hope this was helpful. If you listen to podcasts, click follow so you don't miss another episode. If you're watching on YouTube, click subscribe, and I'll talk to you next week. Take care. Bye.