Type two diabetes used to be considered a disease of adulthood, typically appearing in middle age or later. This assumption is rapidly becoming outdated.
New cases of type two diabetes among children and teenagers in Colorado increased nearly tenfold between 2002 and 2023, researchers at the Colorado School of Public Health have found. Even more concerning, the rate of this increase in diabetes among children and adolescents appears to be accelerating.
To understand how diabetes among young people is changing, researchers examined more than two decades of data from the Colorado Diabetes Registry. The registry has conducted continuous, population-level tracking of new diabetes cases among Colorado residents younger than 20 since 2002. The cases were identified using diagnosis records, laboratory results and medication data gathered across health systems throughout the state.Between 2002 and 2023 there was nearly a tenfold increase in type two diabetes cases per 100,000 adolescents in Colorado.
Between 2002 and 2023, over 8,000 children and teenagers under age 20 were newly diagnosed with type one diabetes. During that same period, 1,560 young people ages 10 to 19 developed type two diabetes, but the difference in the trends is striking. Type one diabetes rates increased only modestly, from 25.07 cases per 100,000 young people in 2002 to 27.39 per 100,000 in 2022. Type two diabetes, however, climbed from 2.37 cases per 100,000 adolescents to 22.30 per 100,000 — nearly a tenfold increase.
“A generation ago, type two diabetes in a teenager was so rare that many pediatric clinicians could go through much of their career without seeing a case; it was a disease of middle age,” lead author of the study, Tessa Crume, an associate professor in the Department of Epidemiology at the Colorado School of Public Health, said in a press release. "In Colorado, we have now watched it rise nearly tenfold in young people in just two decades, and the increase is accelerating rather than slowing.”
The research team believes Colorado may reflect a much broader national problem. Previous U.S. research, including the Search for Diabetes in Youth Study, has also documented a rapid rise in type two diabetes among young people. Why does this matter? Diabetes that begins in childhood or adolescence may be particularly dangerous.Youth-onset type two diabetes often progresses more aggressively than the disease diagnosed in middle age. Blood sugar may be harder to control and serious complications involving the kidneys, eyes, nerves and heart can develop much earlier.
The growing prevalence of obesity among children and teens has also complicated the diagnosis. A teenager with a high body mass index and elevated blood sugar might have either type one or type two diabetes. Doctors may need specialized testing for diabetes-related autoantibodies and insulin resistance, rather than relying on appearance or assumptions.
"The services needed, then, are not only about capacity to treat a growing number of young people; they are about ensuring that every child with new-onset diabetes receives proper autoantibody and metabolic testing rather than being classified on impression,” Crume said.
The Colorado findings offer an unsettling reminder that preventing diabetes cannot rest solely on the shoulders of children.
Families need access to fresh fruits and vegetables, safe places to exercise, healthy school meals and communities where making healthier choices is realistically possible. As type two diabetes increasingly becomes a disease of youth, the question is no longer whether the problem is growing. It is whether communities, health systems and families can move quickly enough to change its trajectory.
