Increasing number of young people developing type 2 diabetes
Recent report highlights that young women are being diagnosed with early-onset type 2 diabetes in England.
Usually, trends in cases of diabetes have appeared to be stable or increasing. However, a recent study has found that while incidence is falling in older adults – who make up the largest proportion of new diagnoses – it is increasing rapidly in people under the age of 40.
In a major population study of type 2 diabetes in England, researchers reported a clear generational divide, with rates of diagnosis rising rapidly among younger adults, particularly in women, although declining in older age groups.
Around 90% of the six million people in the UK living with diabetes have the type 2 form of the condition rather than type 1 that requires treatment with insulin.
Latest figures from NHS England estimate that 12,000 people under the age of 30 are now living with type 2 diabetes, with women making up more of those younger cases.
The research, published in Lancet Regional Health Europe, is the first to examine trends in new diagnoses of type 2 diabetes across the entire English population, while arranging findings by age, sex and ethnicity.
Researchers at Imperial College London analysed English National Diabetes Audit figures and calculated age-standardised incidence rates for adults with type 2 diabetes by age, sex and ethnicity between 2011–2024.
Researchers said this was especially worrying as type 2 diabetes diagnosed at a younger age leads to a longer lifetime exposure to the condition, earlier death and a greater risk of serious complications, including poor pregnancy outcomes in women.
Researchers suggested that current type 2 diabetes prevention strategies could be having less success in younger generations.
In addition, the new report found that younger females (under 40 years) are driving this rising trend.
Previous discussion about rising levels of type 2 diabetes has tended to focus on ethnic minority populations. However, the recent study showed that the increase in younger people’s early-onset type 2 diabetes was not confined to ethnic minority populations. The results showed that the rise was particularly noticeable in White, Asian and Black women aged 20–29 years, and in White women aged 30–39 years.
Dr Shivani Misra, from the Department of Metabolism, Digestion and Reproduction at Imperial College London, who led the study, and also a past DRWF Clinical Fellow and Board of Trustees member, said: “Much of the discussion around rising type 2 diabetes in younger people has focused on ethnic minority groups. While these ethnic groups are disproportionately affected with early-onset type 2 diabetes, we now see that incidence is also increasing in White populations too, showing that this public health challenge is broadening across the generation.”
More overweight people contributing to rising cases of type 2 diabetes
The study also identified a dramatic shift in average body weight at the time of diagnosis. Obesity is already well established as the major risk factor for type 2 diabetes, researchers found that body mass index (BMI) at diagnosis and has been rising more rapidly in younger adults than in older adults.
The increase in BMI over time among younger people diagnosed with type 2 diabetes was approximately double that seen in older adults. This suggested that successive generations of younger adults are developing type 2 diabetes at increasingly severe levels of obesity.
Among some groups, researchers said their figures were particularly striking. White women diagnosed at younger ages had average BMIs approaching 40 kg/m², a level that is classified as severe obesity.
Dr Misra, a Clinical Associate Professor at Imperial, said: “We have known for a long time that obesity is linked to type 2 diabetes, but what is new from this study is the scale of the change occurring in younger adults. We think that the earlier onset of severe obesity in young people is increasing their type 2 diabetes risk in early life and pulling down their age at diagnosis. This is really worrying given the poor health outcomes from early-onset type 2 diabetes and as numbers increase, we need to think about implementing effective treatments as early as possible.”
The analysis shows that older adults are not experiencing as large an increase in BMI at diagnosis, but the reasons remain unclear. However, the study did not examine weight trends in the general population and further research is needed.
The authors say the findings highlight an urgent need to rethink approaches to type 2 diabetes and obesity prevention, with greater focus on reaching younger adults. Potential strategies could include earlier identification of people at risk, encouraging greater participation in diabetes prevention programmes at younger ages, earlier use of effective weight-management treatments such as GLP-1 medicines, and targeted weight-management support for people with severe obesity, for example intensive lifestyle or bariatric surgery. However, researchers stress that population-level prevention still remains crucial.
Dr Misra added: “There are many factors in society today that can contribute to someone developing obesity, from the widespread availability and marketing of unhealthy foods to increasingly sedentary lifestyles, and young people appear to be particularly vulnerable to today's obesogenic environment. If we are serious about reducing the future burden of type 2 diabetes, we need stronger public health measures that create healthier environments and help prevent type 2 diabetes from developing in the first place.”
Diabetes trends
Researchers concluded: “This analysis highlights important shifts in the incidence of type 2 diabetes in England, with rising incidence in younger adults, particularly in females and across all ethnicities, contrasting declining trends at older ages. Tailored, proactive screening and interventions that address these distinct susceptibilities are essential to reverse these trends. By learning from the changes observed in older populations and tailoring prevention approaches to younger adults, there is significant potential to mitigate the rising burden of early-onset type 2 diabetes.”
The authors recommended that age-stratified analyses should become a routine part of assessing type 2 diabetes trends, as national averages may conceal important shifts happening within specific population groups.
The study was funded by the Wellcome Trust and supported by the NIHR Imperial Biomedical Research Centre, a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London.
Read the report in Lancet Regional Health Europe
Read more about type 2 diabetes
Read more about DRWF-funded research
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