Global epidemiology and burden of type 2 diabetes mellitus in children and young adults

Introduction

The global burden of type 2 diabetes mellitus (T2DM) is increasing rapidly, affecting approximately 462 million individuals in 2017 (1). This epidemic is now extending to children and adolescents, particularly those with obesity (2). Risk factors for pediatric T2DM include prediabetes, obesity, inactivity, family history, ethnicity, and poverty (3). The prevalence of T2DM in youth has risen significantly in many countries over the past two decades, with certain ethnic groups disproportionately affected. Developing countries face a unique challenge called the “double burden of malnutrition”, where both undernutrition and overnutrition coexist, potentially predisposing children to malnutrition-modulated diabetes mellitus later in life (4). Screening high-risk children and implementing lifestyle intervention programs have shown promise in preventing T2DM progression and reducing cardiovascular risk factors (5).

T2DM has traditionally been associated with older adults, but its incidence among children and young adults has risen dramatically over the past two decades. This shift is closely linked to the global obesity epidemic, with childhood obesity rates doubling in many regions since the 1990s (6). The rise in T2DM among younger populations is particularly alarming because it is associated with severe long-term complications, including cardiovascular disease, renal failure, and retinopathy, which impose a significant burden on healthcare systems and society at large (7).

The global prevalence of T2DM in children and young adults varies widely, with higher rates observed in certain ethnic groups, such as South Asians, Indigenous populations, and African Americans. For instance, Indigenous populations in North America and Australia have T2DM prevalence rates that are three to four times higher than those of their non-Indigenous counterparts (7,8). Socioeconomic factors, including poverty, food insecurity, and limited access to healthcare, further exacerbate the risk and outcomes of T2DM in these populations (9).

This review aims to provide an overview of the global epidemiology and burden of T2DM in children and young adults, focusing on risk factors, regional disparities, and the socioeconomic impact of the disease. It also highlights emerging strategies for prevention and management, emphasizing the need for a multidisciplinary approach to address this growing public health crisis.

Global epidemiology of T2DM in children and young adults

Prevalence and incidence

Recent studies indicate a sharp increase in the prevalence of T2DM among children and young adults worldwide. In the United States, the SEARCH for Diabetes in Youth study reported a 4.8% annual increase in T2DM incidence among youth aged 10–19 years between 2002 and 2015 (10). This trend is particularly pronounced among minority groups, with African American, Hispanic, and Native American youth experiencing disproportionately higher rates of T2DM compared to their white counterparts (6).

Similarly, a new World Health Organization’s program, Multinational Project for Childhood Diabetes (Diabetes Mondiale or DIAMOND), found a rising trend in T2DM diagnoses among adolescents, particularly in Southern and Eastern Europe. The prevalence of T2DM in these regions is closely linked to increasing rates of obesity and sedentary lifestyles, which are driven by urbanization and changes in dietary habits (11).

In low- and middle-income countries (LMICs), the rise in T2DM among young populations is even more pronounced. For example, in India, the prevalence of T2DM among adolescents has increased by 20% over the past decade, driven by rapid urbanization, economic development, and the adoption of Western dietary patterns (12). In Sub-Saharan Africa, limited data suggest a growing burden of T2DM among young adults, though underdiagnosis remains a significant challenge due to inadequate healthcare infrastructure and limited access to diagnostic tools (13).

Risk factors

The primary risk factors for T2DM in children and young adults include obesity, physical inactivity, and poor dietary habits. Obesity, in particular, is a major driver of insulin resistance, which is a key pathophysiological mechanism underlying T2DM (14). Study has shown that children with obesity are up to four times more likely to develop T2DM compared to their peers with normal weight (6).

Genetic predisposition and family history of diabetes also play a significant role, particularly in high-risk ethnic groups. For example, South Asian and Indigenous populations have a higher genetic susceptibility to insulin resistance and beta-cell dysfunction, which increases their risk of developing T2DM at a younger age (8). Emerging evidence suggests that environmental factors, such as exposure to endocrine-disrupting chemicals (e.g., bisphenol A) and maternal diabetes during pregnancy, may further increase the risk of early-onset T2DM (7).

Regional and ethnic disparities

Significant disparities in T2DM prevalence exist across regions and ethnic groups. Indigenous populations, such as Native Americans and Australian Aboriginals, have some of the highest rates of T2DM among youth globally (7). In the Middle East, countries like Kuwait and Saudi Arabia report high prevalence rates, attributed to rapid economic development, urbanization, and lifestyle changes (9).

In the United States, African American and Hispanic youth are disproportionately affected by T2DM, with prevalence rates that are two to three times higher than those of white youth (10). These disparities are driven by a combination of genetic, socioeconomic, and environmental factors, including limited access to healthy foods, higher rates of obesity, and lower levels of physical activity (6).

Burden of T2DM in children and young adults

Clinical and comorbidities

Early-onset T2DM is associated with a higher risk of complications compared to adult-onset diabetes. Study has shown that young people with T2DM are more likely to develop hypertension, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD). The TODAY study, a landmark clinical trial, found that nearly 60% of youth with T2DM developed at least one complication within a decade of diagnosis, including microvascular complications such as retinopathy and nephropathy (14).

The progression of complications in youth with T2DM is often more rapid and severe than in adults, leading to significant morbidity and mortality. For example, youth with T2DM are at a higher risk of developing cardiovascular disease, which is the leading cause of death among individuals with diabetes (7).

Socioeconomic impact

The economic burden of T2DM in children and young adults is substantial, encompassing direct medical costs, lost productivity, and long-term healthcare expenses. In high-income countries, the annual cost of managing T2DM in youth is estimated to be several thousand dollars per patient, driven by the need for frequent medical visits, medications, and management of complications (6).

In LMICs, the lack of resources for diabetes care exacerbates the financial strain on families and healthcare systems. For example, in India, the cost of managing T2DM in youth can account for a significant proportion of a family’s income, leading to financial hardship and reduced access to care (12). The economic burden of T2DM is further compounded by the loss of productivity due to disability and premature mortality, which disproportionately affects young adults in their prime working years (15).

Strategies for prevention and management

Public health interventions

Effective prevention strategies include promoting healthy lifestyles, improving access to nutritious foods, and increasing physical activity in schools. Public health campaigns targeting obesity and diabetes awareness have shown promise in reducing T2DM incidence in high-risk populations (13). For example, school-based interventions that promote healthy eating and physical activity have been shown to reduce the prevalence of obesity and insulin resistance among children and adolescents (8).

Early screening and multidisciplinary care

Early screening for T2DM in high-risk populations is critical for timely intervention. The American Diabetes Association (ADA) recommends screening for T2DM in children and adolescents who are overweight or obese and have additional risk factors, such as a family history of diabetes or belonging to a high-risk ethnic group (6).

Multidisciplinary care models, involving endocrinologists, dietitians, and mental health professionals, have been shown to improve outcomes in youth with T2DM. For example, the TODAY study demonstrated that intensive lifestyle interventions and pharmacological therapy can significantly reduce the risk of complications in youth with T2DM (14).

Conclusions

The global rise in T2DM among children and young adults underscores the urgent need for comprehensive prevention and management strategies. Addressing this epidemic requires a multifaceted approach, including public health interventions, early screening, and equitable access to healthcare. Future research should focus on understanding the unique pathophysiology of early-onset T2DM and developing targeted therapies to improve outcomes in this vulnerable population.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Public Health and Emergency. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-25-8/coif). S.M.S. serves as an unpaid editorial board member of Journal of Public Health and Emergency from December 2024 to November 2026. The other author has no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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