Type 2 diabetes cases in young people surge nearly tenfold in U.S.

A Colorado study covering more than two decades found a dramatic rise in new cases among 10- to 19-year-olds, while type 1 diabetes increased only slightly

Type 2 diabetes is no longer a disease associated primarily with middle age or older adults. In the United States, its incidence among young people ages 10 to 19 has risen nearly tenfold over the past two decades, according to a new study that will be presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan from September 28 to October 2.

The research, conducted by Tessa Crume of the Colorado School of Public Health and her colleagues, found a sharp increase in new-onset type 2 diabetes among young people since the beginning of the century, with the pace of growth accelerating in recent years.

The study examined long-term trends in both type 1 and type 2 diabetes among young people in Colorado between 2002 and 2023. In the United States, the incidence of both forms of diabetes among children and adolescents has been rising for decades, creating a growing burden of illness and diabetes-related mortality.

Since 2002, the Colorado Diabetes Registry has conducted annual population-based analyses of diabetes incidence among people under 20. The researchers used information collected through health care systems across the state, including diagnostic codes, laboratory results and medication data.

The study included residents of Colorado who were not members of the armed forces or living in institutions at the time of diagnosis. Population figures used to calculate incidence rates were obtained from census data.

For type 1 diabetes, the researchers calculated incidence among people under 20, while type 2 diabetes was assessed among those ages 10 to 19 because cases in children younger than 10 are extremely rare.

Between 2002 and 2023, 8,094 children and adolescents under 20 were newly diagnosed with type 1 diabetes, while 1,560 young people ages 10 to 19 received a new diagnosis of type 2 diabetes.

The incidence of type 1 diabetes increased only modestly, from 25.07 cases per 100,000 people in 2002 to 27.39 in 2023. Rates remained broadly stable between 2002 and 2014 before beginning to rise from 2015 onward.

The picture was dramatically different for type 2 diabetes. Among 10- to 19-year-olds, incidence increased from 2.37 cases per 100,000 in 2002 to 22.30 in 2023, representing an increase of nearly tenfold.

Across the entire 2002-2023 period, the incidence of type 2 diabetes increased by 3.8%. The annual increase was 2.92% between 2002 and 2013, before accelerating to 4.72% per year between 2014 and 2023.

The authors say the findings point to a growing population of young people at risk of developing diabetes-related complications over their lifetimes and highlight the importance of continued, long-term monitoring.

A disease once considered almost exclusively adult

Crume said the scale of the increase represents a major change from the situation physicians encountered only a generation ago.

Until relatively recently, type 2 diabetes in adolescents was so uncommon that many pediatricians could spend much of their careers without encountering a case. It was regarded primarily as an adult disease.

That is no longer the case. In Colorado, the incidence among young people has increased nearly tenfold in just two decades, and the researchers say the trend is accelerating rather than slowing.

Crume also cited the U.S. “Search for Diabetes in Youth” study, which found that type 2 diabetes among young people is increasing at more than twice the rate of type 1 diabetes. Among older adolescents, new cases of type 2 diabetes have already surpassed those of type 1, according to the study.

The researchers say the growing prevalence of obesity among children is also making it increasingly difficult to distinguish between type 1 and type 2 diabetes when an adolescent is first diagnosed.

A teenager with a high body mass index and elevated blood glucose could have either condition. Establishing the correct diagnosis requires testing for diabetes-specific autoantibodies, which are indicators of the autoimmune process associated with type 1 diabetes, as well as an assessment of insulin resistance, which is characteristic of type 2 diabetes.

Because the classification determines treatment, the researchers say an accurate diagnostic pathway is essential.

Medical services, Crume argues, must therefore do more than accommodate a growing number of young patients with diabetes. Every child with newly diagnosed diabetes should undergo the appropriate metabolic testing and screening for autoantibodies rather than being classified solely on the basis of a clinical impression.

The risk of missed diagnoses

The shift in the age profile of type 2 diabetes is also creating challenges outside specialist care. In primary care and community settings, the disease may still be overlooked or misdiagnosed because of the outdated assumption that type 2 diabetes is primarily an adult condition.

Crume noted that 20 years ago a pediatric endocrinologist might have been surprised to encounter an adolescent with type 2 diabetes. Today, she said, it has become an increasingly common condition in clinical practice.

The concern, she added, is that diabetes in young people could still go undetected or be treated incorrectly.

The researchers also warn about the consequences of developing type 2 diabetes at a young age. According to Crume, the disease is more aggressive when it begins during childhood or adolescence than when it is diagnosed in middle age.

Insulin-producing pancreatic cells deteriorate more rapidly, blood glucose can be harder to control, and complications affecting the kidneys, eyes, nerves and heart can emerge within a few years rather than over several decades.

A teenager diagnosed with type 2 diabetes at age 14 could therefore face such complications in early adulthood. Youth-onset type 2 diabetes is also associated with reduced life expectancy, according to the study’s authors.

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