The Rise of Type 2 Diabetes Among Youth and Adolescents: A Q&A with Eric P. Osei, BSN.

Loretta Hsueh, PhD; Asher Eunchae Hong - Diabetes SIG

The prevalence of type 2 diabetes (T2D) among youth and adolescents in the United States (US) has rapidly increased over the past two decades and is an emerging public health concern. Since complications during this critical developmental stage can affect lifetime outcomes, it is crucial to understand better the considerations for treating T2D in this population.

Eric Peprah Osei is a doctoral student at the University of Illinois Chicago School of Nursing whose research focuses on youth-onset T2D, with a specific interest in self-management behaviors, cardiovascular complications, and digital health literacy interventions. The Diabetes SIG sat down with Eric to gain insight into the unique challenges youth and adolescents with T2D face.

1. What do we know about type 2 diabetes among youth and adolescents, and what trends are most concerning to researchers right now?

Type 2 diabetes (T2D), historically known to affect adults, has become increasingly prevalent among youth and adolescents in the United States over the past two decades¹. The National Institute of Diabetes and Digestive and Kidney Diseases report in 2024 indicated that T2D continues to disproportionately affect children and adolescents from racial and ethnic minority populations⁴, with projected cases expected to increase nearly sevenfold by 2060⁵. Youth-onset T2D is of particular concern because it often follows a more aggressive clinical course than adult-onset disease³. Adolescents with T2D are more likely to develop complications such as nephropathy, cardiovascular disease, neuropathy, and retinopathy earlier in life due to accelerated beta-cell dysfunction and metabolic deterioration³. In addition, diagnosis during adolescence occurs during a key period of physical, emotional, social, and academic development, which can negatively impact quality of life and contribute to poorer long-term health outcomes.

2. What are the developmental considerations when treating youth and adolescents living with T2D?

Management of T2D during adolescence must be situated within the broader context of rapid biological, cognitive, emotional, and social development. This developmental stage is characterized by increasing autonomy, identity formation, and heightened sensitivity to peer influence. From a cognitive standpoint, adolescents may have difficulty consistently applying long-term health consequences to daily decision-making, which can affect adherence to treatment regimens. Psychosocially, the desire for independence may lead to resistance to parental or caregiver involvement, even when such support remains essential for disease management. Additionally, puberty-associated hormonal changes contribute to increased insulin resistance, further complicating glycemic control. Effective clinical care, therefore, requires a developmentally responsive, family-centered approach that gradually supports transition to self-management while maintaining appropriate scaffolding from caregivers and healthcare providers⁷.

3. Why are self-management behaviors especially important for youth and adolescents with T2D, and what challenges do young patients commonly face in maintaining them?

Self-management behaviors are central to T2D control and include medication adherence, dietary regulation, physical activity, glucose monitoring, and engagement with healthcare services². In youth-onset T2D, consistent self-management is particularly critical given the disease’s rapid progression and early risk of complications. However, adolescents face unique barriers at multiple levels of the social-ecological system. At the individual level, limited health literacy, emotional distress, and diabetes-related burnout may interfere with adherence. At the interpersonal level, peer influence, stigma, and evolving family dynamics can reduce consistency in self-care behaviors. At the structural level, socioeconomic constraints, food insecurity, limited access to safe spaces for physical activity, and healthcare barriers further complicate adherence. These multilevel challenges underscore that suboptimal self-management is not solely a behavioral issue but reflects broader contextual influences shaping youth and adolescents’ lived realities.

4. What is the psychosocial experience of T2D among youth and adolescents, and how might they differ from the experience of older adults?

The psychosocial experience of T2D among youth and adolescents is shaped by the intersection of a chronic illness with a key developmental stage involving identity formation and peer relationships⁸. At diagnosis, youth and adolescents often experience strong emotional reactions, including shock, fear, confusion, shame, and distress, alongside limited understanding of the condition. Many youth and adolescents perceive T2D as an “old person’s disease” or as being associated with being “unhealthy,” “lazy,” or “overweight,” which reinforces stigma and contributes to feelings of difference and social marginalization. These perceptions increase concerns about peer judgment and bullying, often leading to selective disclosure or concealment of the diagnosis. Living with T2D is frequently described as burdensome due to ongoing self-management demands such as medication use, glucose monitoring, and dietary changes, which can feel overwhelming alongside school and social pressures. However, some youth and adolescents report gradual adaptation and increased confidence over time. Compared with older adults, adolescents experience greater psychosocial strain because they are simultaneously managing a chronic condition and normative developmental tasks such as autonomy development and peer acceptance.

5. In your view, where are the biggest gaps in current research?

Several key gaps remain in the literature on youth-onset T2D. There is a need for longitudinal studies following adolescents into adulthood to understand better long-term outcomes and care transitions⁶, as well as for more culturally tailored, family-centered intervention studies. Research also needs greater focus on mental health outcomes, including diabetes distress and psychosocial resilience, alongside stronger examination of social drivers of health such as food insecurity, neighborhood safety, and healthcare access. Evidence on digital health tools, mobile interventions, and peer-support approaches remains limited. In addition, more inclusive research is needed to represent better racially, ethnically, and socioeconomically diverse populations disproportionately affected by T2D. Further work should also explore how schools, communities, and healthcare systems can collaborate more effectively to support self-management.

6. What advice would you give other SBM members who want to support better youth and adolescent management of T2D?

To better support adolescents with T2D, SBM members should adopt a developmentally informed, socially contextualized, and patient-centered approach grounded in behavioral science principles. At the clinical level, interventions should prioritize nonjudgmental, strengths-based communication strategies that enhance autonomy while maintaining appropriate support systems. Family involvement should be carefully balanced to avoid undermining youth and adolescent independence while consistently reinforcing self-management behaviors. At the behavioral level, incorporating evidence-based strategies such as goal-setting, problem-solving training, and habit formation techniques may improve adherence.⁹ Screening for psychosocial distress and integrating mental health support into routine care is also essential.

At the structural level, SBM members can advocate for interventions that address food insecurity, school-based health support, and access to safe environments for physical activity. Finally, youth and adolescents should be engaged as active collaborators in the design of interventions, ensuring that programs are developmentally appropriate, culturally relevant, and responsive to their lived experiences.

References:

1. Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016. JAMA Pediatr. 2020;174(2):e194498.
2. Peprah Osei, E. (2026). Prevalence and predictors of prediabetes/type 2 diabetes mellitus among adolescents in the United States: NHANES (2021–2023). PLOS Global Public Health, 6(2), e0005596.
3. TODAY Study Group. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021;385(5):416–26.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK Recent Advances & Emerging Opportunities. 2024. http://www.niddk.nih.gov/about-niddk/strategic-plans-reports/niddk-recent-advancesemerging-opportunities
5. Centers for Disease Control and Prevention. (2024). Diabetes in young people is on the rise. https://www.cdc.gov/diabetes/data-research/research/young-people-diabetes-on-rise.html
6. Corbett, T., & Smith, J. (2025). Supporting adolescents with type 1 diabetes during the transition from child to adult services: a literature review. Primary Health Care, 35(5).
7. Hagger, V., Hendrieckx, C., Sturt, J., Skinner, T. C., & Speight, J. (2016). Diabetes distress among adolescents with type 1 diabetes: a systematic review. Current diabetes reports, 16(1), 9.
8. Oxlad, M., Smith, L., McNamara, T., Young, A., Borrowdale, E., & Pena, A. S. (2026). Psychosocial experiences of adolescents with type 2 diabetes: a systematic review and meta-synthesis. Canadian Journal of Diabetes, 50(2), 115-123.
9. Osei, E. P., Antwi, E. O., Ekpor, E., Osei, G. Y., Asante, A., Dzotrah, G. E., & Boakye, M. D. S. (2026). Adolescents' experiences of living with type 2 diabetes mellitus: A scoping review. Journal of Pediatric Nursing, 87, 160-172.