Epidemiology

There has been a dramatic increase in the number of patients with type 2 diabetes mellitus (T2DM). During 2019, the number of people in the US with a diagnosis of diabetes was estimated to be 28.7 million (8.7% of the US population).[6] The total included 283,000 children and adolescents ages under 20 years with diagnosed diabetes (equivalent to 35 cases per 10,000 youths), 39,000 of whom had T2DM.[6] Between 2001 and 2017, the greatest increases in type 2 diabetes prevalence were seen in black and Hispanic youth.[7]

American-Indian children were the first to have been reported as having T2DM, with a 1% prevalence as early as 1979.[8] 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.[9][10][11]​ Between 1990 and 1998, the number of American-Indian and Alaskan native children diagnosed with T2DM increased by 71%.[10] Although the risk groups can vary from country to country, the most at-risk group globally are Asian Indians.[12] As compared with white children, those of Asian Indian ancestry manifest adiposity, insulin resistance, and metabolic perturbations of obesity earlier in life, and have a tendency toward central adiposity even with a similar body mass index (BMI).[13] One third of Latino children and youths with diabetes in Southern California and over two-thirds of those in South Texas have T2DM.[14][15]​ Ethnic differences in background insulin sensitivity are also indicated by studies from Cincinnati, Arkansas, and Texas, where African-Americans account for 70% to 75% of pediatric T2DM.[16][17]

Globally, the incidence and prevalence of T2DM in children vary widely between countries, with the lowest incidence rates observed in European countries.[18] In the UK, young people ages <16 years identified with T2DM between 2012 and 2013 had an overall prevalence rate of 2.9 in 100,000.[19] In 2014, the prevalence of T2DM in children and adolescents was 0.6 in 100,000 inhabitants in Denmark.[20] One study of T2DM among children and adolescents in Germany in 2016 had a prevalence rate of 2.42 in 100,000.[21]

In young-onset type 2 diabetes, females are affected more than males.[9] The average age of diagnosis of T2DM is 13.5 years (i.e., during puberty).[22]

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.[23] The increasing rate of T2DM with the concurrent increase in the rate of obesity is also observed in children in Japan, Thailand, China, India, New Zealand, Australia, and throughout Europe.[24][25]​

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