No longer just a condition of middle age, type 2 diabetes is increasingly affecting children, teenagers and young adults in New Zealand. And our health system is nowhere near ready to manage this surge.
Type 2 diabetes is a condition where the body stops properly using insulin, the hormone that helps control blood glucose. Glucose then builds up in the blood. Over time, that can damage the heart, kidneys, eyes, nerves and more.
This condition is more aggressive in young people. It progresses faster, causes complications earlier, and is harder to manage, often due to the accumulation of damage across their lifetime. People with young-onset type 2 diabetes also tend to die earlier than those diagnosed later in life.
Our research looks at who has been diagnosed with type 2 diabetes across the Waikato and Auckland regions of New Zealand. From a dataset of more than 65,000 people with type 2 diabetes, 1,198 were aged under 25 years.
More than a quarter of people (28.0%) with diabetes under the age of 25 had type 2 diabetes (the rest mostly have type 1 diabetes – an unrelated autoimmune condition), up from less than 5% of this age group 20 years ago.
Further, only one in four young people with type 2 diabetes meet their blood glucose (HbA1c) targets, meaning a higher need for more doctor visits, more medication, and more chance of serious problems later on.
This rise in under 25s with type 2 diabetes has been flagged in recent years, but our research gives a clear picture of just how worrying the trend is.
Even though all young people with diabetes have access to specialist care, healthcare access remains challenging for many, particularly Maori and Pacific communities which are disproportionately affected.
And the pressure isn’t just on patients – it’s on the entire health system.
Young people with type 2 diabetes may need care, medication and effective treatment plans for the rest of their lives. That means higher costs for general practice, increased demand on diabetes clinics, and a growing strain on hospitals and emergency services.
There are also rising wellbeing costs associated with young-onset type 2 diabetes. These young people often miss school or work. They struggle with the emotional toll of living with a chronic illness. Some lose trust in a health system that doesn’t always meet their needs, and for some it feels like the start of a long, unsupported journey.
Addressing the deeper causes
There’s no one cause for young-onset type 2 diabetes. Obesity is a huge factor. Nearly 90% of young people in our research were overweight or obese, and childhood obesity has been rising in New Zealand for years.
Poverty plays a big role, too. It’s harder for families with less money to buy healthy food or get access to regular healthcare.
Health inequality in New Zealand also matters. Type 2 diabetes can be inter-generational and children born to mothers with diabetes are at a much higher risk of developing the disease.
Opportunities to turn this rising tide exist, but it needs a multi-pronged approach. That starts with addressing child poverty, making healthy food affordable and accessible, and making sure families have the support they need.
Patients need to be well-supported right from their time of diagnosis.
This means culturally respectful care, better access to medications and tech and making sure no one is left behind just because of their postcode or their background.
Managing type 2 diabetes in young people is also not the same as managing it in older adults. Clinicians need appropriate support to provide integrated care, including resources and programmes that are age appropriate.
Ideally, we also need to screen and detect those at high risk early on.
Young-onset type 2 diabetes screening programmes have been effective in other countries such as the United States but are not yet widespread in New Zealand.
Timely screening of at-risk asymptomatic young people could catch type 2 diabetes early, delaying or even preventing serious complications. Yet right now, many young people are being diagnosed late.
The increase in type 2 diabetes in young people demands serious investment, coordinated effort and long-term commitment. With better detection, smarter treatment plans, and a stronger, more connected health system, the problem can be addressed.
Lynne Chepulis receives funding from the Health Research Council of New Zealand.
