Type 2 diabetes (T2D) is increasingly affecting children and adolescents, a trend that raises significant public health concerns. Once primarily seen as an adult-onset disease, T2D diagnoses among youth have surged from just 1% to 2% before the mid-1990s to between 24% and 45% today, with the average age of diagnosis now around 13 years. Research from the Charles E. Schmidt College of Medicine at Florida Atlantic University highlights a crucial factor in this alarming trend: the environment in which a child lives.
Using data from the National Survey of Children’s Health collected between 2016 and 2020, the researchers conducted a large-scale study focusing on children from birth to age 5, a demographic often overlooked in T2D research. The study analyzed responses from caregivers of over 174,000 children nationwide, including nearly 50,000 from the early childhood group. The aim was to investigate how various factors, including neighborhood conditions and household characteristics, might impact T2D risk.
The findings, published in the journal Pediatric Research, indicate that social and environmental factors may play a more significant role in the development of T2D than individual behaviors alone. While the overall prevalence of T2D in children under age 5 remained low and stable, certain characteristics associated with neighborhoods and households were found to correlate with increased diagnoses.
Neighborhood Influence on Health
Notably, the study found that proximity to a library was significantly associated with childhood T2D diagnoses in both 2016 and 2020. This suggests that neighborhoods with libraries may reflect broader patterns that promote sedentary lifestyles, as these environments often encourage indoor activities over outdoor physical engagement. Typically, libraries are found in urban areas, which may have less walkability and fewer green spaces.
“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 Lea Sacca, Ph.D., the study’s senior author and assistant professor of population health at the Schmidt College of Medicine.
Caregivers reported increasing neighborhood issues, such as litter and vandalism, which grew steadily between 2016 and 2020. These environmental concerns were noted across the overall sample and particularly in the youngest age group studied. Other significant associations included receiving assistance from neighbors and neighborhood walkability, suggesting that community support and infrastructure play roles in health outcomes.
The Complexity of Food Security
The study also revealed that access to government assistance programs, including free or reduced-cost meals, showed a connection to neighborhood and household characteristics. From 2019 to 2020, there was a marked increase in the use of such programs, indicating a growing reliance on government support. While these programs aim to mitigate food insecurity, their impact on nutrition quality is less straightforward.
Participation in programs like the Supplemental Nutrition Assistance Program (SNAP) and school meals has been linked to an increased intake of processed, energy-dense foods high in sugar and fat, which may in turn contribute to T2D risk. “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 noted.
Children from food-insecure households often demonstrate poorer blood sugar control and higher hospitalization rates. Some studies even suggest that participants in food assistance programs may have worse diet quality compared to non-participants from similar income backgrounds.
Effective prevention and early detection of T2D must take into account both environmental factors and food quality. This includes assessing neighborhood designs and access to nutritious foods to create lasting change. Despite the complexities, obesity remains the strongest risk factor for T2D in children, with significantly overweight children being four times more likely to develop the disease by age 25 compared to their healthy-weight peers.
The urgency of addressing this issue is underscored by the rising rates of childhood obesity. With nearly 70% of children aged 2 to 5 consuming sugar-sweetened beverages daily, health experts stress the need for robust interventions. While some school policies, such as vending machine restrictions, have led to slight decreases in consumption, overall intake remains high.
The researchers advocate for more assertive measures, such as comprehensive bans on sugary beverages in schools and higher taxes on these drinks. Successful school-based initiatives have shown that improving dietary habits and increasing physical activity among children is achievable with the right support.
“The rise in early-onset type 2 diabetes is a growing public health concern,” Sacca emphasized. “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.”
The study was co-authored by several medical students from FAU, including Ayden Dunn, Paige Brinzo, Sahar Kaleem, Austin Lent, Madison Etzel, Jennifer Mendonca, Vama Jhumkhawala, and Milad Khoury, M.D., a clinical affiliate assistant professor of endocrinology in FAU’s Department of Medicine.
The findings highlight the need for a multi-faceted approach to tackle the rising rates of T2D in children, focusing not only on individual lifestyle changes but also on the broader social and environmental context in which children grow and develop.
