Diabetes in children and teens is typically associated with type 1 diabetes, an autoimmune disorder that results in an inability to make insulin. But now type 2 diabetes is on the rise among children and teens, according to the National Institutes of Health (NIH).

The Centers for Disease Control and Prevention (CDC) reports that as of 2015 more than 5,700 children and adolescents ages 10 to 19 years were being newly diagnosed with type 2 diabetes each year. Who is most affected? The NIH stated that in 2017 the rate of newly diagnosed cases rose by 8.5 percent in Asian Americans and Pacific Islanders and 6.3 percent in non-Hispanic Black youths ages 10 to 19, with smaller increases seen in Hispanic (3.1 percent) and white youths (0.6 percent). The rate for the Native American young people studied was highest (8.9 percent), but could not be generalized to all Native American youth nationwide.

The rise of type 2 diabetes in young people from Black, Indigenous, and People of Color (BIPOC) communities — and youth in general — is a phenomenon that the pediatric endocrinologist Sheila Perez-Colon, MD, who is Hispanic, links to another growing trend among youngsters: obesity. “I see obesity in children younger than age 10. It’s currently an epidemic in pediatrics, due to sedentary lifestyles and how we’re eating,” says Dr. Perez-Colon, who practices at Kidz Medical Services in Miami and Hialeah, Florida.

What Causes Type 2 Diabetes at a Young Age?

Historically known as “adult-onset diabetes” because it typically begins in middle age, type 2 diabetes is a disease caused by insulin resistance, which develops when the body can’t use insulin properly and blood sugar (glucose) levels are too high, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Elevated blood sugar that does not rise to the level of diabetes is known as prediabetes, and is a risk factor for the later development of type 2 diabetes.

Insulin resistance usually starts during puberty, explains Perez-Colon. “Typically the range is 10–19 years of age.” The body becomes less sensitive to insulin during this time of metabolic change, but the reasons why are not well understood, according to research published July 2016 in Current Diabetes Reports.

One way to measure blood sugar is through a hemoglobin A1C test, which gives a two- to three-month average measurement of how much glucose attaches to the hemoglobin in red blood cells. A normal A1C level is below 5.7 percent, according to the NIDDK. Between 5.7 and 6.4 percent indicates prediabetes, and a level of 6.5 percent or above means a person has diabetes.

Which Youth Are Most at Risk of Developing Type 2 Diabetes?

A child wouldn’t be screened for prediabetes or type 2 diabetes until age 10 or the start of puberty (whichever comes first), according to American Diabetes Association (ADA) guidelines. But the CDC describes risk factors that may set a child on a path to those conditions years before that, including:

Family history
Excess weight
Sedentary lifestyle
High blood pressure
High cholesterol
Low-income status
Being Black, Hispanic or Latino, Native American or Alaska Native, Asian American, or Pacific Islander
Mother had gestational diabetes

Obesity is among the modifiable risk factors. Between 1971 and 2000 the rate of obesity more than tripled in youth ages 6 to 11 and more than doubled in those ages 12 to 19, from 4 to 15.3 percent for both age ranges, according to the National Academy of Sciences. The CDC reports that obesity in youth ages 2 to 19 stood at 18.5 percent in 2016, affecting about 13.7 million children and adolescents. Hispanic (25.8 percent) and non-Hispanic Black children (22 percent) had higher obesity rates than non-Hispanic white children (14.1 percent).

Why Are BIPOC Youth Especially at Risk of Developing Obesity and Type 2 Diabetes?

Perez-Colon says economic status may play a role in the racial and ethnic disparities. Black and Hispanic households have higher poverty rates and lower average incomes than white households in the United States. In 2018, the median Black household earned just 59 cents for every dollar of income that the median white household earned, and the median Hispanic household earned 73 cents, according to a 2019 Economic Policy Institute analysis of U.S. Census Data.

“If children are of low socioeconomic status then that can trigger a whole chain of factors leading to higher risk for diabetes — for example, factors that prevent them from getting healthy diets,” Perez-Colon says. “Eating more lean protein and more vegetables in a healthy diet is costly, versus eating an unhealthy diet of fast food that is much cheaper.” According to a previous analysis of diet studies across the globe, the healthiest diets cost on average $1.48 per day more than the least-healthy diets.

A sedentary lifestyle can be linked to socioeconomic status as well, she adds. “For example, their neighborhood could be unsafe, so they don’t go out to play outside. Or maybe there are fewer parks in their neighborhood.” A review published in June 2017 in Sports Medicine found that among adolescents ages 10 to 19, lower socioeconomic status was associated with higher amounts of sedentary behavior — but only in high-income countries such as the United States. In particular, lower socioeconomic status was associated with a higher amount of TV and screen time among adolescents. What’s more, a study published in September 2017 in BMC Public Health found that teenagers ages 14 to 18 who perceived their neighborhoods as unsafe had 21 percent reduced odds of being physically active on five or more days of the prior week compared with those who felt safe.

Cultural factors can play a role too, says Perez-Colon. “I’m Hispanic, and I know even in my own family that years ago my grandmother would tell us, ‘You are too thin, you look unhealthy.’ They believe gaining weight is healthy. We need to change that cultural belief, to say, ‘No, that’s not correct.”

There’s also evidence that Black and Hispanic youth are more exposed than their white counterparts to advertisements for sugary drinks that put them at risk for obesity and developing diabetes. A June 2020 report by the Rudd Center for Food Policy and Obesity at the University of Connecticut found that sports drink brands disproportionately advertised on Spanish-language TV, dedicating 21 percent of their TV advertising budgets to Spanish-language TV. Also, Black children and teens saw more than twice as many sugary drink ads compared with white children and teens. Black youth exposure was especially high for sports drinks, energy drinks, and regular soda. A past analysis of studies found that drinking 1–2 servings of sugar-sweetened beverages per day was associated with a 26 percent greater risk of type 2 diabetes.

Meanwhile, a rule proposed by the U.S. Department of Agriculture (USDA) in January would reduce the amount of healthy vegetables and fruits required in meals provided through school breakfasts and lunches, while allowing more pizza, burgers, and french fries to be available to students. Black and Hispanic youth are more likely to take part in national school meal programs than their white counterparts, according to the agency.

“Before COVID-19, you had to ask: Are school meals healthy and good for my child’s blood sugar?” says Tracey Brown, the CEO of the ADA, who is Black. The COVID-19 pandemic has changed a lot of things, but the importance of nutritious school meals isn't one of them. It’s still important for parents whose children are getting school-provided meals to push for better nutrition, she says. Her organization is calling for the USDA to rescind the proposed changes out of concern that they could promote obesity in children and increase their risk of type 2 diabetes.

Perez-Colon would also like to see changes to what children are eating in school, including fewer refined carbohydrates (which tend to quickly spike blood sugar); more whole, fresh vegetables; fewer sweetened beverages; and no vending machines. “Also, I would like to see more obesity prevention programs in communities of color, for free, where families can go and learn how to cook, [learn] what is healthy and how to read food labels.”

What Are the Symptoms of Type 2 Diabetes in Children and Teens?

Many of the signs of type 2 diabetes are the same in children as they are in adults. The ADA lists these as common symptoms:

Frequent urination
Frequent thirst
Feeling very hungry even if you are eating well
Fatigue

Perez-Colon also looks for weight gain around the middle. In addition, she is watchful for acanthosis nigricans: a velvety darkening and thickening of the skin that usually happens around the neck and skin folds and which can be a sign of type 2 diabetes, according to the ADA. Research indicates that it is more common among Native American, Black, and Hispanic people in the United States.

A big tipoff for her that a child is at risk of obesity, and perhaps type 2 diabetes, comes from lifestyle. “Most of the time they have a sedentary lifestyle and barely do physical activities. Diet-wise, they are drinking an increased amount of juice or sweetened drinks. They are not eating much in the way of fruit or vegetables. They are eating a lot of salty foods, such as chips. They may be eating very late at night, which can predispose you to putting on weight. And they eat large portions, getting seconds and sometimes even thirds.”

What Are the Complications of Type 2 Diabetes in Youth?

When youth under age 20 develop type 2 diabetes, complications arise at an accelerated pace, according to a September 2016 report in the ADA’s journal Diabetes Care. Furthermore, the risk of death is twofold higher for those who develop type 2 diabetes under 20 than it is for the general population under 20, according to a 2018 study.

Many of the complications are similar to those seen in adults. According to the ADA, complications of diabetes include:

Diabetic neuropathy (nerve damage, especially in the extremities)
Retinopathy (eye disease)
Kidney disease
High blood pressure
High cholesterol
Stroke

Perez-Colon has seen these complications in her own young patients. She stresses that good blood sugar management can help children avoid complications down the road.

And while Perez-Colon says there isn’t yet enough data to know how a COVID-19 infection can affect a child or teen with type 2 diabetes, she notes that having an infection can cause the body to release hormones that raise your blood sugar — another reason for being vigilant about blood sugar management. Adults with type 2 diabetes are certainly at risk for serious COVID-19 illness, according to the CDC.

How Do You Treat Type 2 Diabetes in Children and Teens?

Perez-Colon focuses on lifestyle changes first, particularly for children who are younger than 10 and are deemed at risk for developing type 2 diabetes. “We are making sure they have increased physical activity, and we give them a detailed education on what is a healthy diet.”

Physical activity is important because it helps the body use insulin better, according to the CDC. Aim for your child to get 60 minutes of physical activity a day, and try to make it fun. Team sports, family outings, or making a game out of household chores are among their suggestions. The agency also advises limiting screen time to two hours per day.

With regard to diet, the CDC recommends drinking more water and fewer sugary drinks; limiting consumption of sugar and saturated fat; increasing the proportion of fruits, vegetables, whole grains, and lean proteins; making meal portions smaller overall; and not eating in front of a screen.

Yet it’s not enough to treat only the child, says Perez-Colon. “It has to be a plan for all of the family members. If the mother, for example, is eating an unhealthy diet and drinking Coca-Cola or drinking juice every morning and telling an 8-year-old not to drink it, that will confuse the child and the kid will not follow those instructions.” Using a family approach will boost the health of every family member, she adds.

If you’re not sure where to get fresh produce to improve your family’s meals, or have a hard time affording it, Perez-Colon recommends speaking to your doctor or certified diabetes educator for a referral. Some localities, such as New York City and Washington, DC, have robust farmers market programs even during the COVID-19 pandemic, with programs for reduced-cost produce.

For help, the ADA has an online Diabetes Food Hub tool that allows you to view the nutrition information for meals and drag and drop them into a meal planner. The tool also allows you to compare these meals to goals set by your child’s registered dietitian nutritionist, certified diabetes care and education specialist, or doctor. Registration is free.

Beyond lifestyle interventions, the ADA’s guidelines include treatment with the oral drug metformin in addition to insulin if necessary for young people over age 9, or at onset of puberty, who have been diagnosed with type 2 diabetes and need medication to control it.

Your child’s healthcare team may recommend using a glucose meter or a continuous glucose monitor to aid with blood sugar management.