Pediatric diabetes rate climbs 11.4% among Medicaid, CHIP enrollees

An 11.4% overall increase in pediatric diabetes prevalence among Medicaid and Children’s Health Insurance Program (CHIP) enrollees from 2016 to 2021 reflects a combination of behavioral, systemic, and potentially biologic factors, according to Hao Zhang, PhD, MPH, and Biaskha “Pia” Sen, PhD, assistant professor and professor, respectively, at the University of Alabama at Birmingham.

The sharpest rise occurred in 2021, prompting researchers to consider the downstream effects of the COVID-19 pandemic. Lifestyle disruptions during quarantine—including reduced physical activity, dietary changes, and heightened psychological stress—may have contributed to increased risk.

At the same time, pandemic-era policy changes likely influenced detection rates. Continuous enrollment requirements under the Centers for Medicare & Medicaid Services kept more children insured, including many who previously cycled on and off coverage. Expanded insurance access may have increased health care utilization and, in turn, diabetes diagnoses that otherwise might have gone undetected.

Sen also noted emerging—but not yet confirmed—speculation that exposure to SARS-CoV-2 itself could increase susceptibility to diabetes in children and adolescents. While evidence remains inconclusive, this hypothesis warrants further investigation.

Type 2 diabetes (T2D) rose by 24.3%, with particularly rapid increases among male patients and youths in the western United States—groups historically considered lower risk. Rather than traditional high-risk populations driving the surge, these data suggest that previously lower-risk groups are “catching up.” The findings underscore the need to avoid complacency and to revisit screening guidelines to ensure they reflect shifting epidemiology.

An urban–rural divide further complicates the picture. Rural youths maintained greater baseline prevalence, possibly because of reduced access to healthy foods and recreational infrastructure. However, urban youths experienced faster relative growth in prevalence.

Researchers speculate that pandemic-related stressors and sedentary behaviors may have had a stronger impact in urban settings. Additionally, improved screening access in urban areas—where primary care availability is typically greater—may have increased detection.

Given that nearly half of US youths rely on Medicaid or CHIP, pediatric providers play a central role in early identification and long-term management. Missed screening opportunities remain a concern, particularly for T2D. Zhang and Sen recommend more proactive risk assessment, stronger engagement with families, and improved health literacy outreach. Policy-level strategies—such as mandated body mass index documentation in Medicaid claims—may nudge providers toward increased screening.

While lifestyle interventions remain foundational, Sen suggests that broader access to emerging therapies, including GLP-1 receptor agonists, may become an important adjunct in addressing accelerating pediatric T2D among socioeconomically vulnerable populations.

No relevant disclosures.

Opinions expressed here are solely personal opinions of Dr. Sen and Dr. Zhang and do not represent UAB's views.

Reference

Zhang H, Giannouchos T, Becker D, et al. Pediatric diabetes prevalence among Medicaid beneficiaries. JAMA Netw Open. 2026;9(2):e2560507. doi:10.1001/jamanetworkopen.2025.60507