Type 2 diabetes, once considered an adult disease, is rising sharply among children. Before the mid-1990s, only about 1% of youth with diabetes had type 2. Today, that number is as high as 45%, with the average diagnosis occurring at age 13.
A new study from Florida Atlantic University’s Charles E. Schmidt College of Medicine suggests that where a child grows up may play as big a role as what they eat. The research, published in Pediatric Research, used national survey data from more than 174,000 children collected between 2016 and 2020. It focused on children from birth to age 5, an age group rarely examined in diabetes research.
The findings show that social and environmental factors such as walkability, access to nutritious food and neighborhood conditions may shape type 2 diabetes (T2D) risk even before children start school.
“Research has shown that neighborhood environments — such as the presence of sidewalks, parks or other green spaces — can directly influence a child’s ability to engage in physical activity, and in turn, affect their risk of developing chronic diseases like type 2 diabetes,” said Dr. Lea Sacca, senior author and assistant professor of population health at FAU.
Caregivers who reported litter and vandalism in their neighborhoods were more likely to have children with T2D, while limited access to green space and walkable areas showed similar links. Participation in food assistance programs such as SNAP and free school meal plans also increased during the study period. While these programs help reduce hunger, they can sometimes lead to greater reliance on low-cost, energy-dense foods that are high in sugar and fat.
“While this finding could suggest improved access to food, previous research shows that relying on food assistance doesn’t always equate to better nutrition,” Sacca said. “For instance, children in food-insecure households tend to have poorer blood sugar control and higher hospitalization rates.”
The researchers stress that environment and policy must be part of diabetes prevention, especially as childhood obesity continues to climb. Children who are significantly overweight are four times more likely to develop type 2 diabetes by age 25 than those with a healthy weight.
“One particularly urgent target is reducing consumption of sugar-sweetened beverages, which are closely linked to both obesity and diabetes risk,” Sacca noted. Nearly 70% of children aged 2 to 5 drink sugary beverages daily.
To make real progress, the study’s authors recommend a comprehensive approach that includes improving access to nutritious foods, investing in walkable and safe neighborhoods, and supporting policies that promote health from the earliest stages of life.
“The rise in early-onset type 2 diabetes is a growing public health concern,” Sacca said. “Addressing it requires a comprehensive strategy that includes improving access to nutritious foods, creating healthier neighborhood environments and investing in policies that promote long-term wellness from the very start of life.”
This research was conducted by the Charles E. Schmidt College of Medicine at Florida Atlantic University. It was supported by FAU medical students and affiliated researchers, including faculty from the Department of Medicine and the Division of Endocrinology.