Type 2 diabetes in the young

Key facts

  • Type 2 diabetes in the young is a global phenomenon that is on the increase.
  • Children are being affected in both developed and developing nations.
  • The risk of type 2 diabetes is clearly linked to an increasing prevalence of obesity, which is associated with changing dietary and lifestyle patterns.
  • Studies have shown that youth with type 2 diabetes will also develop diabetes related micro- and macro-vascular complications, as with adults.
  • The increasing prevalence of type 2 diabetes in the young may be blunted by encouraging more physical activity, and changing dietary habits.   

The prevalence of type 2 diabetes increases with age and affects some 17% of all 65-74 year olds in the US, and a similar proportion in other countries1Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998; 21:518-524. 2Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA, Dwyer T, Colagiuri S, Jolley D, Knuiman M, Atkins R, Shaw JE. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2002; 25:829-834. 3Callahan ST, Mansfield MJ. Type 2 diabetes mellitus in adolescents. Curr Opin Pediatr 2000; 12:310-315.. Amongst the young, type 2 diabetes is thought to account for 2-3% of all types of diabetes. This, however, is likely to be an underestimate as, depending on the study, 8-45% of recently diagnosed diabetes in the young in the USA is due to type 2 diabetes4Anonymous. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care 2000; 23:381-389.. Data from the third National Health and Nutrition Examination Survey (NHANES III) in the USA indicate that 16 million Americans have type 2 diabetes1Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998; 21:518-524..

There are ever increasing reports of type 2 diabetes in children worldwide, with some as young as eight years of age being affected5Pihoker C, Scott CR, Lensing SY, Cradock MM, Smith J. Non-insulin dependent diabetes mellitus in African-American youths of Arkansas. Clin Pediatr (Phila) 1998; 37:97-102.. These are mostly in ethnic groups known to be at high risk of type 2 diabetes. However, there are now also reports of type 2 diabetes occurring amongst white Caucasian teenagers6Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP. Type 2 diabetes in obese white children. Arch Dis Child 2002; 86:207-208.. In Japan, the prevalence of type 2 diabetes amongst junior high school children has almost doubled from 7.3 per 100,000 in 1976-80 to 13.9 per 100,000 in 1991-5, with type 2 diabetes now outnumbering type 1 diabetes in Japanese children7Kitagawa T, Owada M, Urakami T, Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila) 1998; 37:111-115..

Compared to adults, there is little information on type 2 diabetes incidence and prevalence in the young with many surveys being clinic based or case series with a paucity of population-based surveys, particularly outside North America and Japan. Similarly, unlike adults, information on the natural history and aetiology of type 2 diabetes in the paediatric age range is also sparse. There is also a lack of uniformity in case definition, data collection and follow-up, with the diagnosis often made retrospectively8Dabelea D, Pettitt DJ, Jones KL, Arslanian SA. Type 2 diabetes mellitus in minority children and adolescents. An emerging problem. Endocrinol Metab Clin North Am 1999; 28:709-729..

Despite these weaknesses, it is now becoming recognized that type 2 diabetes in children is becoming a global public health issue with potentially serious health outcomes9Fagot-Campagna A, Narayan KM, Imperatore G. Type 2 diabetes in children. BMJ 2001; 322:377-378.. In response to this the American Diabetes Association (ADA) has issued a consensus statement on the screening, diagnosis and treatment of children with type 2 diabetes4Anonymous. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care 2000; 23:381-389..

Data tables

The data presented in the tables are results as presented in the original papers. In some of the studies used, the prevalence of type 2 diabetes in the general population (child and adolescent) was determined from a representative population-based sample. However, many studies have simply reported a series of cases, sometimes supplemented by a calculation of the prevalence in the general population, using estimated figures for the size of the population from which the cases were drawn, or examined only a specific sub-population, such as from a diabetes registry or an obesity clinic. Further details of methodology and discussion of results are available in the Diabetes Atlas, second edition.

Back to Top