Young-onset type 2 diabetes (T2D) is an aggressive form of diabetes associated with substantially increased risks of cardiovascular disease and mortality compared with later-onset T2D. The increasing burden of T2D among young adults has become a pressing concern worldwide. Based on the age at diagnosis, young-onset T2D can be further classified into youth-onset T2D (<18 years) and young-adult-onset T2D (18–44 years). While extensive research has been conducted on youth-onset T2D in children and adolescents, the incidence and risk factors of young-adult-onset T2D remain insufficiently studied.
Recently, a research team led by Professor Victor Wenze Zhong from the School of Public Health, Shanghai Jiao Tong University, published a study titled “Incidence and Risk Factors of Diagnosed Young-Adult-Onset Type 2 Diabetes in the U.S.: The National Health Interview Survey 2016–2022” in the renowned diabetes journal Diabetes Care. This study, based on cross-sectional data from the U.S. National Health Interview Survey (NHIS) from 2016 to 2022, assessed the incidence and risk factors of young-adult-onset T2D in the U.S., providing crucial scientific evidence for developing targeted public health interventions.
This study analyzed 142,884 adults aged 18–79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016–2022, representing the noninstitutionalized U.S. civilian population. All cases with diabetes of 0-year duration and half of the cases with 1-year duration were treated as incident (newly diagnosed) cases. Incidence of diagnosed T2D was calculated for three age groups: young-adult onset (18–44 years), middle-age onset (45–64 years), and older-adult onset (65–79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D.
The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1000 adults. Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared with their counterparts. The strongest risk factors were obesity, use of antihypertensive medications, and use of lipid-lowering medications. These risk factors, along with hypertension, hyperlipidemia, and coronary heart disease, were more strongly associated with young-adult-onset T2D compared with later-onset T2D, with adjusted odds ratios as high as 4.5 times greater.
This study is important as it quantified the incidence of diagnosed young-adult-onset T2D in the U.S. and identified its distinct risk factor profile. The findings highlight the need for precision prevention strategies targeting racial/ethnic minorities, socioeconomically disadvantaged groups, and individuals with cardiometabolic conditions. Public health policies should emphasize early screening and health management among young adults, promoting dietary improvements, physical activity, and weight control to effectively reduce the disease burden.
The study’s co-first authors are Dr. Lan Xu and Dr. Jinjun Ran, while Professor Victor Wenze Zhong served as the corresponding author. All three researchers are affiliated with the School of Public Health, Shanghai Jiao Tong University School of Medicine. Co-authors included Professor Hui Shao (Emory University, USA), Dr. Feng Tao and Dr. Zhenxiu Liu (Shanghai Municipal Hospital of Traditional Chinese Medicine). Furthermore, Dr. Marc Rosenman (Northwestern University Feinberg School of Medicine, USA) provided critical review and guidance to improve the manuscript.
This work was supported by the National Key R&D Program of China (2022YFC2705203 and 2023YFC2506700), the National Natural Science Foundation of China (82373551), Shanghai Key Discipline of Public Health Grants Award (GWVI-11.1-20), the Innovative Research Team of High-Level Local Universities in Shanghai, the Fundamental Research Funds for the Central Universities (YG2023QNB03), the Shanghai Jiao Tong University Young Faculty Initiation Program (KJ3-0221-22-6313), and the Shanghai Science and Technology Development Fund (22YF1421100).