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A new analysis of Global Burden of Disease (GBD) data covering 204 countries finds a sharp global rise in diabetes among children and adolescents from 1990 to 2021, led by a surge in type 2 diabetes (T2D). Although diabetes-related deaths in this age group have declined overall, the rapid increase in new cases—particularly among older adolescents—poses a significant public health challenge for pediatric care, school health programs, and health systems worldwide.
The growing threat of diabetes in young people
Diabetes is a chronic metabolic disease most often characterized by insulin deficiency or resistance. Globally, diabetes affected hundreds of millions of people by 2019 and is projected to rise further by 2045, increasing strain on health services. Traditionally dominated by type 1 diabetes (T1D) in children, the epidemiology is shifting: T2D—historically an adult condition linked to obesity and lifestyle—now accounts for a larger share of new pediatric cases in many regions. Early-onset diabetes has long-term consequences for cardiovascular, renal, and neurological health and increases lifetime healthcare needs.
Study design and key findings
Researchers used GBD 2021 to examine incidence, mortality, and disability-adjusted life years (DALYs) for diabetes in people younger than 20 between 1990 and 2021. Countries were grouped by Socio-Demographic Index (SDI) into five categories (low to high) and by age subgroups (under 1 year, 2–4, 5–9, 10–14, 15–19). While the GBD lists many possible attributable risk factors, the available child/adolescent data were sufficient only for elevated fasting glucose and extreme temperatures.
Key quantitative results:
- Global diabetes incidence among children and adolescents rose ~94%, from 25.77 per 100,000 in 1990 to 49.99 per 100,000 in 2021.
- Incidence of T2D outpaced T1D, making T2D the principal contributor to the rising case load; T1D still accounts for higher mortality per case.
- Diabetes-related mortality fell from 0.39 to 0.31 per 100,000 between 1990 and 2021, though T2D mortality showed a slight increase (0.06 to 0.08 per 100,000).
- DALYs decreased modestly overall (39.45 to 37.83 per 100,000), with T2D DALYs rising while T1D DALYs declined.
Regional patterns showed the highest incidence in Oceania and the largest recent increases in East Asia, North Africa, and the Middle East. India and China reported the greatest absolute numbers of pediatric diabetes cases; Pakistan also recorded substantial increases. The highest incidence occurred in the 15–19 age group, with elevated T1D mortality and DALYs concentrated among infants under one year.
Implications, limitations and future prospects
Implications: The shift toward more T2D in younger age groups underscores the role of obesity, sedentary lifestyles, and social determinants of health in diabetes emergence. Health systems should expand pediatric screening, strengthen school- and community-based prevention (nutrition and activity programs), and broaden access to pediatric endocrinology services, insulin management and diabetes education. Emerging technologies—continuous glucose monitoring (CGM), telemedicine for remote diabetes care, and data-driven risk stratification—can improve early detection and long-term control.
Limitations: Findings rely on GBD aggregate data and uneven country reporting; many regions likely undercount undiagnosed pediatric diabetes and lack comprehensive exposure data for known risk factors. The study could not apply individual-level epidemiologic methods to explain causal pathways. Projections using ARIMA models forecast continued rises in pediatric incidence over the next 15 years while mortality trends are expected to decline, amplifying the need for prevention and surveillance.
Expert Insight: "The rise in type 2 diabetes among adolescents is a red flag for public health," says Dr. Maya Fernandes, pediatric endocrinologist. "We need integrated prevention—from primary care screening to school-based nutrition policies—and better data systems to identify at-risk youth early. Advances in CGM and telehealth can reduce complications, but prevention remains essential."
Conclusion
Global data show a near doubling of diabetes incidence in children and adolescents between 1990 and 2021, driven chiefly by increases in T2D. Although mortality and overall DALYs have decreased slightly—reflecting improved clinical care—rising incidence, particularly among older adolescents and in specific regions, threatens long-term child and adolescent health. Policymakers, clinicians, and communities must prioritize prevention, screening, equitable access to care, and improved epidemiological surveillance to limit the growing pediatric diabetes burden.
Source: news-medical
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