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Advancing Care for Youth-Onset Type 2 Diabetes, an Urgent and Evolving Public Health Issue

Advancing Care for Youth-Onset Type 2 Diabetes, an Urgent and Evolving Public Health Issue 1024 589 Madison Storm
Young adult using a finger-prick device to check blood sugar levels while holding a glucose meter, standing at a kitchen counter with a small medical kit nearby.

Type 2 diabetes was once considered an adult-only condition, but today, that paradigm has shifted dramatically. Pediatric endocrinologists are caring for a growing and increasingly complex population of young patients with type 2 diabetes, underscoring the urgency of effective care. 

“Youth-onset type 2 diabetes is no longer rare – it’s an urgent and rapidly evolving public health issue,” says Leena Mamilly, MD, pediatric endocrinologist at Nationwide Children’s and assistant professor of pediatrics at The Ohio State University. “What we’re seeing now demands a fundamental rethinking of how we approach both treatment and long-term care.”  

A Growing and Disproportionate Burden 

Early reports of type 2 diabetes in children date back to the early 1980’s, but rates have accelerated globally in recent years. While type 1 diabetes remains more common in pediatric populations, the incidence of type 2 diabetes is increasing at a much faster pace, with research showing annual increases exceeding 7% in youth-onset cases. 

This rapid rise is particularly concerning given how differently the disease presents in pediatric patients. 

“Youth-onset disease progresses differently than adult-onset type 2 diabetes,” Dr. Mamilly explains. “It tends to be more aggressive, with earlier onset of complications and a higher overall disease burden.” 

Youth with type 2 diabetes face increased risk of retinopathy, cardiovascular disease, neuropathy and nephropathy. Beyond physical complications, many also experience depression, anxiety, sleep disturbances and stigma related to both diabetes and weight.  

“These young patients are navigating a condition that affects nearly every aspect of their health and wellbeing,” says Dr. Mamilly. “It’s not just about blood glucose levels — it’s about quality of life.”  

Compounding the challenge, the disease disproportionately affects historically marginalized populations, including racial and ethnic minority groups, underscoring longstanding health disparities.  

Shifting the Treatment Paradigm 

Historically, treatment options for youth with type 2 diabetes were limited, often centered on lifestyle modifications and metformin, with insulin added as needed. However, this approach has not always been sufficient to control disease progression and manage comorbidities. 

Professional portrait of Leena Mamilly, MD

“We’ve learned that early, aggressive intervention is critical,” Dr. Mamilly says. “Waiting for treatment failure is not a strategy that serves these adolescents well.”  

Recent advances have begun to transform care. New pharmacologic therapies — including glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose transporter 2inhibitors (SGLT2i) — are expanding the treatment toolkit and offering improved glycemic control alongside benefits such as weight reduction or the potential to lower the risk of complications.  

“These therapies represent a significant step forward,” Dr. Mamilly notes. “They allow us to address multiple aspects of the disease simultaneously, which is especially important in youth-onset cases.” 

However, medication is only one piece of the puzzle. Effective care requires a comprehensive, multidisciplinary approach that addresses behavioral health, nutrition, lifestyle, family dynamics and social determinants of health. 

“At Nationwide Children’s, we’ve built a dedicated type 2 diabetes program to support these patients holistically,” says Dr. Mamilly. “Our goal is to meet patients where they are and provide coordinated care that reflects the complexity of this condition.” 

Looking Ahead: Two Paths 

As incidence rates continue to rise, modeling studies suggest that without intervention, youth-onset type 2 diabetes could increase drastically in coming decades, placing immense strain on patients, families and health systems. This highlights the importance of type 2 diabetes prevention programs in youth. 

At the same time, growing awareness and innovation offer an opportunity to shift that trajectory. 

“With growing awareness, better data and expanding treatment options, we are in a position to change the trajectory of this disease,” Dr. Mamilly says. “The key is recognizing that youth-onset type 2 diabetes requires its own distinct approach — not a scaled down version of adult care.” 

Efforts at Nationwide Children’s and across national collaboratives are focused on improving outcomes through quality improvement initiatives, education and research — areas in which Dr. Mamilly plays a leading role.  

“This is a pivotal moment,” she adds. “If we act now — with urgency and intention — we can improve not only clinical outcomes but the lifelong health of these patients.”  

Dr. Mamilly recently gave a Grand Rounds Presentation on this topic. Watch the full grand rounds presentation: Treatment of Type 2 Diabetes in Youth: A New Landscape. 

References:  

Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J. Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012. New England Journal of Medicine. 2017;377(3):301. 

Tönnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D’Agostino RB, Hoyer A, Imperatore G. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2060: the SEARCH for diabetes in youth study. Diabetes Care. 2023;46(2):313-320. 

About the author

Senior Strategist, Research Communications | Website

Madison Storm is the Senior Strategist of Research Communications at Nationwide Children's Hospital. She earned her bachelor's in multimedia journalism from Virginia Tech in 2021 and went on to achieve her master's in health communication from Johns Hopkins University in 2023. Her passion for transforming the complex to clear is supported by various experiences writing for consumer audiences.

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