In less than a decade, the proportion of kids ages 12 to 19 with diabetes or prediabetes has jumped from 9% in 1999-2000 to 23% in 2007-2008.

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Nearly 1 in 4 U.S. teens is on the fast track to diabetes, if they don’t already have the disease, according to research from the Centers for Disease Control and Prevention (CDC) that was published Monday in Pediatrics.

In less than a decade, the proportion of kids ages 12 to 19 with diabetes or prediabetes has jumped from 9% in 1999-2000 to 23% in 2007-2008. The statistic is concerning on its own, but considering that the American Heart Association tags diabetes as one of a handful of major “controllable risk factors” for cardiovascular disease, it’s even more important to pay attention.

Cardiovascular disease is the top cause of death among U.S. adults, often leading to stroke and heart attacks. While heart attacks and strokes typically don’t occur until adulthood, CDC researchers found that in many cases, the 3,400 teens studied had an alarming number of cardiovascular risk factors. Most unnerving was the conclusion that 37% of normal-weight teens had at least one risk factor. “I was a little surprised given they are at normal weight,” says Ashleigh May, a CDC epidemiologist and the study’s lead author. “It just speaks to the fact that we have to promote health and wellness for all youth and not just those we know are overweight or obese.”

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Sifting through nine years of comprehensive data from 1999 to 2008 from the National Health and Nutrition Examination Survey, researchers found that 49% of overweight teens and nearly two-thirds of obese teens had one or more risk factors, plus the complicating factor of their weight.

Risk factors included prehypertension/hypertension, borderline and high LDLC (the “bad” cholesterol), low HDLC (the “good” cholesterol) and prediabetes and diabetes.

Among those adolescents who were overweight or obese, 26% also had prehypertension or hypertension, as well as borderline or high LDL. That percentage has not fluctuated significantly since 1999, nor has the proportion of obese teens changed, which may explain why hypertension and “bad” cholesterol rates haven’t jumped.

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But with such a sizable increase in the prevalence of teen diabetes, researchers have plenty of work cut out for them. “Will we continue to see this increase or will prediabetes and diabetes also plateau in future years?” says May.

A plateau — or, even better, a decrease — isn’t likely to happen without significant public-health efforts promoting healthy lifestyles.