Youth-onset type 2 diabetes may progress faster, signs easy to miss

Type 2 diabetes (T2D) that starts in childhood or adolescence often takes a more aggressive course than adult-onset disease. Its early presentation can also be vague enough to go unnoticed, according to pediatric endocrinologists at Nationwide Children's Hospital in Columbus, Ohio.¹ An estimated 8 million US children and adolescents have prediabetes, and the team is calling for risk-based screening and family-centered lifestyle intervention to slow progression.¹

"Diabetes is a chronic condition. When it's diagnosed, it doesn't go away. It impacts people for life," said Leena Mamilly, MD, assistant professor of pediatric endocrinology and a diabetes clinic leader at Nationwide Children's.¹

Beta-cell decline and complications in youth-onset type 2 diabetes

Mamilly noted that youth with T2D can lose insulin-producing beta-cell function more steeply than adults, and they also tend to have greater insulin resistance.¹ That pattern matches long-term follow-up from the TODAY study, which tracked 500 participants diagnosed with T2D in adolescence into young adulthood.² The participants had a mean age of about 26 years and had lived with diabetes for roughly 13 years on average. By then, 60% had at least 1 diabetes-related complication and nearly one-third had 2 or more, and glycemic control had declined steadily over time.² Investigators found that complication risk, including microvascular disease, rose steadily and affected most participants by young adulthood.²

Atypical presentation of pediatric type 2 diabetes

Classic hyperglycemic symptoms are not always what brings a child in. The hospital described Grace Cashion, a 13-year-old from Ohio who had months of stomach pain. At a routine visit, she was found to have elevated blood glucose and was diagnosed with T2D.¹ "Definitely a shock to hear that, going from stomach upset to that diagnosis," said her mother, Stephanie Cashion.¹

Her care team recommended working with a dietitian, eating more whole foods at home, and walking after meals. According to the hospital, she now has control of her diabetes and no longer requires insulin.¹ Single-patient outcomes are anecdotal, however, and should not be generalized.

ADA screening recommendations for prediabetes and type 2 diabetes in youth

The American Diabetes Association (ADA) Standards of Care in Diabetes—2026 recommend considering risk-based screening for youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) who have at least 1 additional risk factor.³ Screening should begin after the onset of puberty or at age 10 years, whichever comes first.³ Risk factors include a first- or second-degree relative with T2D; maternal diabetes or gestational diabetes during the child's gestation; higher-risk race or ethnicity; and signs of insulin resistance or conditions linked to it, such as acanthosis nigricans, hypertension, dyslipidemia, or polycystic ovary syndrome.³ If results are normal, testing should be repeated at least every 3 years, or sooner if BMI is rising or the risk profile worsens.³

Family-centered lifestyle interventions for pediatric prediabetes

Nationwide Children's clinicians recommend that families make changes together: aiming for about 1 hour of daily movement, starting with simple steps such as a walk after dinner; replacing sugary drinks and processed snacks with water, fruits, and vegetables; and planning balanced weekly meals built on whole grains, vegetables, and lean proteins.¹

"It's important to screen for it, and it's important to also apply those lifestyle interventions, especially in the young pre-pubertal years," Mamilly said.¹

References

1. Nationwide Children's Hospital. Type 2 diabetes can progress faster in kids, but the warning signs may be easy to miss. News release. Newswise. October 12, 2026. Accessed October 12, 2026. https://www.newswise.com/articles/type-2-diabetes-can-progress-faster-in-kids-but-the-warning-signs-may-be-easy-to-miss

2. TODAY Study Group; Bjornstad P, Drews KL, Caprio S, et al. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021;385(5):416-426. doi:10.1056/NEJMoa2100165

3. American Diabetes Association Professional Practice Committee. 14. Children and adolescents: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S297-S320. doi:10.2337/dc26-S014