Youth type 2 diabetes cases rising nearly 10-fold in Colorado

Youth type 2 diabetes cases: what happened in Colorado

Youth type 2 diabetes cases in Colorado rose nearly 10-fold since 2002, based on new research being presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Milan (Sept. 28 to Oct. 2).

The analysis looked at long-term trends in youth-onset type 1 and type 2 diabetes in Colorado from 2002 through 2023 and found that type 2 diabetes incidence increased sharply and accelerated in recent years compared with a much smaller rise in type 1 diabetes.

Youth type 2 diabetes cases: what the evidence shows

The evidence comes from continuous, population-level annual analyses in the Colorado Diabetes Registry, which tracks diabetes incidence among people younger than 20 across health systems in the state using diagnosis codes, lab results, and medication data.

Eligible participants were nonmilitary, noninstitutionalized people living in Colorado at diagnosis, and population denominators came from census data. Incidence was reported per 100,000 people younger than 20 for type 1 diabetes and per 100,000 youth ages 10 to 19 for type 2 diabetes because cases under age 10 are described as extremely rare.

• From 2002 to 2023, 8,094 children and teens under 20 were newly diagnosed with type 1 diabetes, and 1,560 youth ages 10 to 19 were diagnosed with new-onset type 2 diabetes.
• Type 1 diabetes incidence increased from 25.07 per 100,000 (2002) to 27.39 per 100,000 (2023).
• Type 2 diabetes incidence among ages 10 to 19 increased from 2.37 per 100,000 (2002) to 22.30 per 100,000 (2023).
• For type 1 diabetes, the trend was stable from 2002 to 2014 (annual percentage change 0.66%), then increased from 2015 to 2023 (annual percentage change 2.62%).
• For type 2 diabetes, the incidence increased across 2002 to 2023 and was steeper from 2014 to 2023 (annual percentage change 4.72%) than from 2002 to 2013 (annual percentage change 2.92%).

Why youth type 2 diabetes cases matter for metabolic health

The authors state that the rise in new-onset type 2 diabetes in youth documents an expanding population at risk for diabetes-related complications across the life course and supports the need for sustained long-term surveillance.

Dr. Tessa Crume of the Colorado School of Public Health said that type 2 diabetes in teenagers used to be so rare that many pediatric clinicians might not see a case, but Colorado has seen a near tenfold rise over two decades and the increase is accelerating rather than slowing.

• The study contrasts a near tenfold rise in youth type 2 diabetes with a slight increase in youth type 1 diabetes over the same period.
• The researchers frame this as a growing long-term health burden because more people are developing diabetes earlier in life.
• The report also points to a broader U.S. pattern described by Dr. Crume, citing the SEARCH for Diabetes in Youth study as showing youth type 2 diabetes climbing more than twice as fast as type 1 and overtaking type 1 among older teenagers.

Youth type 2 diabetes cases and diagnosis: why classification is harder

Rising obesity rates in children mean clinicians cannot reliably distinguish type 1 from type 2 diabetes based only on how a newly diagnosed teenager looks or presents clinically, according to the authors.

They note that a teen with a high BMI and high blood sugar could have type 1 or type 2 diabetes, and that correct classification affects treatment.

• The authors describe autoantibody testing as a marker of the autoimmune process of type 1 diabetes.
• They also describe testing for insulin resistance as part of identifying type 2 diabetes.
• They conclude that diagnostic pathways need to be established to support correct diagnosis.

Limitations and what this study does and does not answer

This report summarizes registry-based incidence trends in Colorado and does not, by itself, identify why youth type 2 diabetes cases increased or which risk factors changed over time.

The findings apply to nonmilitary, noninstitutionalized youth living in Colorado at diagnosis and use registry methods based on diagnosis codes, lab results, and medication data, with statistical modeling to estimate trends.

• The analysis covers incidence (new cases) from 2002 to 2023; it does not report outcomes after diagnosis.
• It focuses on Colorado and may not match trends in every state or region.
• The type 2 diabetes incidence estimates are presented for ages 10 to 19 because type 2 diabetes under age 10 is described as extremely rare.