Epidemiology

There has been a dramatic increase in the number of patients with type 2 diabetes mellitus (T2DM). During 2021, the number of people in the US with a diagnosis of diabetes was estimated to be 29.7 million (8.9% of the US population).[7] The total included 352,000 children and adolescents ages under 20 years with diagnosed diabetes (equivalent to 35 cases per 10,000 youths), 48,000 of whom had T2DM.[7] Cases of early-onset T2DM are increasing rapidly globally alongside rising obesity; from 1990 to 2019, significant increases in age standardized incidence rate and age standardized disability adjusted life years (DALY) rate were found for T2DM in adolescents and young adults.[8][9]​​ Modeled data show that for the period 2002-2018, overall incidence of T2DM among US children and adolescents ages 10-19 years significantly increased for all racial and ethnic groups, especially Asian or Pacific Islander, Hispanic, and non-Hispanic black children and adolescents. Non-Hispanic black children and adolescents had the highest incidence of type 2 diabetes across all years.​[7]​ In England, there was a 54% increase in the number of children and young people with T2DM from 2016/17 to 2022/23.[10]

American-Indian children were the first to have been reported as having T2DM, with a 1% prevalence as early as 1979.[11] The majority of childhood-onset T2DM occurs in children from a high-risk racial/ethnic background; these include African-American, Latino, American-Indian, and Asian or Pacific Islander.[12][13][14]​​ Between 1990 and 1998, the number of American-Indian and Alaskan native children diagnosed with T2DM increased by 71%.[13]​ In the US, the highest prevalence of T2DM per 1000 youth in 2017 was observed among black or African-American youth at 1.80, followed by 1.63 in American-Indian youth, 1.03 among youth of Hispanic origin, 0.59 among Asian/Pacific Islander youth, and 0.20 among non-Hispanic white youth.[15]​ While type 1 diabetes remains the predominant form of diabetes in children and adolescents, prevalence of T2DM is now higher than that of type 1 diabetes among American-Indian youth.[15]​

Globally, the incidence and prevalence of T2DM in children vary widely between countries. Prevalence is highest among adolescents in Brazil (33 per 1000), the Ontario First Nations People (5.7 per 1000), and youth in Mexico (4 per 1000), followed by black youth (1.8 per 1000) and American-Indian youth (1.63 per 1000) in the US. Lowest prevalences are observed in Denmark (0.6 per 100,000) and England and Wales (2.9 per 100,000).[16]​ Direct comparisons of country-specific statistics should be made with caution, however, given the lack of universal diagnostic criteria for youth-onset type 2 diabetes.[16]

In young-onset T2DM, females are affected more than males.[12] The average age of diagnosis is 14 years (i.e., during puberty).​[17]

A constant in the increasing emergence of T2DM in young patients has been the increasing rate of obesity. The US National Health and Nutrition Examination Survey, conducted between 2003 and 2006, found that 31.9% of children ages 2-19 years had overweight (BMI >85th percentile for age) and 11.3% had obesity (BMI >97th percentile for age). Apart from the doubling in the frequency of childhood obesity since 1980, the severity was also greater.[18] The increasing rate of T2DM with the concurrent increase in the rate of obesity has also been observed in children in Japan, Thailand, China, India, New Zealand, Australia, and throughout Europe.[19][20]​ Researchers project a fourfold increase in prevalence of youth-onset T2DM in the US by 2050, with the most substantial increases occurring among racial and ethnic minority youth, particularly those of black or indigenous populations.[16]

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