Listen to the audio version of this article (AI-generated).
Tackling childhood obesity is one of our best tools for turning the tide on type 2 diabetes. For many years, paediatric diabetes care largely meant caring for children with type 1 diabetes. This outlook is changing. Rapid urbanisation, sedentary lifestyles and dietary changes are driving an increase in type 2 diabetes among children, a condition once seen only in older adults. Unlike type 1 diabetes, paediatric type 2 diabetes can be prevented.
Growth of type 2 diabetes in youth
Type 2 diabetes in children is also rising rapidly, although comprehensive global data remain limited. South Asia, the Middle East and parts of Africa are seeing increasing numbers of cases, driven by childhood obesity, reduced physical activity and the widespread availability of calorie-dense, nutrient-poor foods. Landmark prevention trials, such as the Finnish Diabetes Prevention Study, the US Diabetes Prevention Program, and the Indian Diabetes Prevention Program, have consistently shown that structured lifestyle interventions can reduce the risk of developing type 2 diabetes by as much as 58%. Although encouraging, these findings underline the need for culturally adapted interventions that address the specific needs of diverse populations.
One of the biggest reasons we are now seeing type 2 diabetes in teenagers – and even younger children – is the surge in childhood obesity. Extra body fat, especially around the abdomen, leads to insulin resistance, which can set the stage for type 2 diabetes.
Paediatric type 2 diabetes is rising worldwide, particularly in LMICs. Hotspots are found in the Pacific Islands, Latin America and among Indigenous youth populations. According to the IDF Diabetes Atlas report on Diabetes among Indigenous Peoples, Indigenous communities such as First Nations youth in Canada and Torres Strait Islander youth in Australia experience some of the highest rates of type 2 diabetes in adolescence, with prevalence climbing sharply during the teenage years.
Structured lifestyle interventions can reduce the risk of developing type 2 diabetes by as much as 58%
Many factors beyond obesity influence type 2 diabetes in children and adolescents, and understanding these risks can contribute to prevention. A strong family history of diabetes is one of the most important predictors. In a major US study of young people with type 2 diabetes, almost 60% had a parent with the condition, and nearly 90% had an affected grandparent. Children exposed to maternal obesity or diabetes in utero have a much higher chance of developing diabetes themselves, often at a younger age and with poorer insulin-producing cell function. Researchers believe this increased risk originates from changes in the way the metabolism is programmed before birth, which can, in turn, create a multi-generational risk.
Early life factors also contribute. Both very low and very high birth weights, as well as preterm birth, are linked to a greater likelihood of type 2 diabetes later in life. Socioeconomic status adds complexity: in high-income countries, children from lower-income families are at increased risk due to barriers to healthy nutrition, safe exercise spaces and healthcare access. This demographic also has a higher incidence of preterm births, thus further increasing a person’s risk of developing type 2 diabetes in childhood or adolescence. In some developing countries, higher-income groups may be more affected due to diets high in processed foods and sedentary lifestyles.
During the COVID‑19 pandemic, diagnoses of type 2 diabetes in young people rose sharply, reflecting weight gain, reduced activity, stress and possibly viral effects on the pancreas. Genetics further shape risk, with studies identifying several key gene variants linked to early‑onset diabetes.
In a major US study of young people with type 2 diabetes, almost 60% had a parent with the condition, and nearly 90% had an affected grandparent
Although the concept of diabetes prevention dates back to 1921, rigorous diabetes prevention research and clinical trials only gained momentum in the 1990s. Evidence from major prevention trials tells us that making changes to diet and physical activity can reduce the risk by more than half.
As the diabetologist Dr Amit Gupta noted during a symposium session at the IDF World Diabetes Congress 2025, type 2 diabetes is largely preventable, but only if evidence-based interventions are implemented and adapted to reach those most at risk. Addressing these inequities is no longer optional. Every child, no matter where they live, deserves the chance to live a healthy and full life with diabetes.
These two forms of diabetes differ in their causes and management. Yet, they share a critical need for timely diagnosis, appropriate treatment and sustained support to prevent complications later in life and to improve long-term health outcomes.
Managing type 1 diabetes in children typically involves daily insulin treatment, regular blood glucose monitoring, a balanced diet, and regular physical activity. For children with type 2 diabetes, lifestyle interventions focusing on improved nutrition, increased physical activity and weight management form the cornerstone of treatment. When lifestyle measures alone are insufficient, oral medications such as metformin are introduced, and in some cases, insulin may also be required. Co-existing health risks, such as high blood pressure or lipid abnormalities, must also be addressed.
The IDF 2025 session also emphasised that physical activity is at the centre of the prevention and management of type 2 diabetes. Dr Noël Barengo explained that even 30 to 60 minutes of moderate exercise each week helps reduce the risk of diabetes. This practice brings even more benefits when combined with dietary improvements.
These two forms of diabetes differ in their causes and management. Yet, they share a critical need for timely diagnosis, appropriate treatment and sustained support to prevent complications
However, these treatments are not reaching all who need them. Children in LMICs face profound challenges in accessing even the most basic components of diabetes care. Insulin – declared an essential medicine by the World Health Organization – remains unaffordable for many families, and stockouts are common.
Modern insulins and continuous glucose monitoring (CGM), which improve quality of life and long-term health outcomes, are often unavailable or priced far beyond the reach of most families. In addition, the lack of structured education means many caregivers are left to navigate complex treatment regimens without adequate support. Health systems in these countries often lack trained paediatric endocrinologists, meaning children are frequently managed in general clinics with limited resources and expertise.
Policy gaps further exacerbate these challenges. In many LMICs, paediatric diabetes is not adequately integrated into national non-communicable disease strategies, and universal health coverage rarely extends to insulin, glucose monitoring supplies or specialist care. School-based health programmes that could support early prevention in children at risk are often underdeveloped or absent. This lack of coordinated policy not only limits access to treatment but also increases the social isolation and stigma experienced by children living with diabetes.
In addition, national guidelines on clinical protocols for diabetes management in many LMICs are often poorly aligned with international standards. They can be unclear and do not address the needs of children and adolescents. A systematic review of type 2 diabetes guidelines found that only 18% identified policymakers as a target audience, and few incorporated strategies tailored to paediatric care. Health financing also remains a critical barrier. Although some countries have introduced universal health coverage, these schemes often exclude essential items, such as insulin, glucose monitoring devices, and specialist paediatric services, leaving families to rely on out-of-pocket spending or temporary donor support.
A further gap lies in early detection: UNICEF and NCD Child report that national non-communicable disease and child health strategies frequently omit provisions for school-based screening and community referral systems, thereby undermining opportunities for timely diagnosis and intervention.
A systematic review of type 2 diabetes guidelines found that only 18% identified policymakers as a target audience, and few incorporated strategies tailored to paediatric care
In order to close gaps in paediatric diabetes care, governments should integrate paediatric diabetes into national health strategies, expand financing for essential medicines and technologies, and establish early detection frameworks that bridge health and education sectors. Without such reforms, children in LMICs will continue to face preventable complications and premature mortality from diabetes.
Strengthening primary healthcare systems is the first step to ensure earlier diagnosis and timely referrals. Expanding access to affordable insulin and glucose monitoring technologies must become a priority for governments, with strategies that include bulk procurement, price negotiations and partnerships with non-profit organisations. We have seen improvements when healthcare workers, particularly those in rural or underserved areas, receive training in diagnosis and diabetes management.
Schools are also a factor in raising awareness, supporting affected children and promoting healthy lifestyles to prevent type 2 diabetes. Importantly, lifestyle interventions must be adapted to local contexts, building on the evidence from landmark trials while considering cultural, economic and social realities.
Schools are also a factor in raising awareness, supporting affected children and promoting healthy lifestyles to prevent type 2 diabetes
Global and local partnerships have a significant role to play. Programmes such as Life for a Child have demonstrated that providing insulin, education and basic monitoring leads to dramatic improvements in survival and quality of life for children with diabetes in LMICs. The Type 1 Diabetes Index, developed collaboratively by Breakthrough T1D, the International Diabetes Federation, ISPAD, and Life for a Child, is providing critical data to inform advocacy and policy. Community-based advocacy, too, is vital. Reducing stigma, engaging families and creating culturally sensitive education campaigns can empower communities and improve adherence to treatment.
Paediatric diabetes is a growing global health challenge, but it is one we have the tools to address. Insulin access, early diagnosis and structured care should not be privileges enjoyed by a few; they are fundamental rights for all children. Landmark trials have shown that type 2 diabetes is preventable, and type 1 diabetes, when properly treated, does not have to be fatal in childhood. To close the gap, governments, global health agencies and donors must prioritise paediatric diabetes in health planning, ensure universal access to essential medicines and technologies, and invest in education and prevention. The lives and futures of millions of children depend on it.
