It is no longer a middle-aged condition, and type 2 diabetes is increasingly affecting children, teenagers and young adults in New Zealand. And our health system is not ready to manage this surge.
Type 2 diabetes is a condition in which the body properly stops using insulin, a hormone that helps control blood sugar. Glucose then accumulates in the blood. Over time, it can damage the heart, kidneys, eyes, nerves, etc.
This condition is more aggressive in young people. It progresses faster, causes more complications, and is often difficult to manage because of the build-up of damage throughout life. People with juvenile type 2 diabetes also tend to die faster than those diagnosed later in their lives.
In our study, people have been diagnosed with type 2 diabetes across the Waikato and Auckland regions of New Zealand. From a data set of over 65,000 people with type 2 diabetes, 1,198 people were aged under the age of 25.
Over a quarter of diabetes under the age of 25 (28.0%) had type 2 diabetes (mainly type 1 diabetes – with an unrelated autoimmune condition), up from less than 5% of this age group 20 years ago.
Furthermore, only one in four young people with type 2 diabetes meet the target of blood glucose levels (HBA1C), making it more likely that more physician visits, more drug therapy and even more serious problems.
This rise of less than 25 seconds has been flagged by type 2 diabetes in recent years, but our study clearly shows how worried the trend is.
While all diabetic youth will have access to specialized care, access to healthcare remains challenging for many people, especially for the disproportionately affected Māori and Pacific communities.
And the pressure isn't just about the patients. It lies in the entire health system.
Young people with type 2 diabetes may need care, medication, and effective treatment plans for the rest of their lives. This means higher general practice costs, increasing demand for diabetes clinics, and an increased burden on hospitals and emergency services.
There is also an increase in welfare costs associated with early onset type 2 diabetes. These young people often miss school or work. They suffer from the emotional sacrifice of living with a chronic illness. Losing trust in the healthcare system that doesn't always meet your needs, for some, it feels like the beginning of a long, unsupported journey.
Address deeper causes
There is no cause of type 2 diabetes in early stages. Obesity is a major factor. Almost 90% of the youth in our study are overweight or obese, and childhood obesity has increased over the years in New Zealand.
Poverty also plays a major role. It is difficult for families who are less likely to buy healthy foods or have access to regular health care.
Health inequality in New Zealand is also important. Type 2 diabetes is intergenerational, and children born to diabetic mothers are at a much higher risk of developing the disease.
There is an opportunity to change this rising tide, but a multifaceted approach is required. It starts by dealing with child poverty, making healthy foods affordable and accessible, and ensuring the support that families need.
Patients need to be supported accurately from the time of diagnosis.
This means being culturally respectful, improving access to medicines and technologies, and not leaving anyone behind due to zip codes or backgrounds.
Management of type 2 diabetes in young people is not the same as managing it in older people. Clinicians need the appropriate support to provide integrated care, including resources and programs of the right age.
Ideally, high-risk individuals should be screened and detected early.
Young-onset type 2 diabetes screening programs are effective in other countries such as the US, but have not yet spread in New Zealand.
Timely screening of risk-free asymptomatic youths can catch type 2 diabetes early and delay or even prevent serious complications. However, so far, many young people have been diagnosed late.
An increase in type 2 diabetes in young people requires serious investment, coordinated efforts and long-term commitment. Better detection, smarter treatment plans, and a stronger, more connected health system will help you address your problems.