UNC Health Care
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A Growing Epidemic: Type 2 Diabetes on the Rise in Children

Learn why more children are being diagnosed with this condition and how to prevent it.

Once upon a time, type 2 diabetes was called adult-onset diabetes because it almost exclusively affected adults. Back then, virtually all children with diabetes had the type 1 form of the disease, but that’s no longer the case. In recent years, the rate of newly diagnosed cases of type 2 diabetes in children has increased significantly.

In fact, the SEARCH for Diabetes in Youth study found that from 2002 to 2012, the rate of newly diagnosed cases of type 1 diabetes in youth increased about 1.8 percent each year; for type 2 diabetes in youth, it was a 4.8 percent increase per year.

To understand the trend and what parents can do to prevent type 2 diabetes in their children, we talked to UNC diabetes experts Ali S. Calikoglu, MD, Elizabeth Mayer-Davis, PhD, and Dianne Stanton Ward, EdD, to learn more.

Type 2 Diabetes Defined

A quick diabetes explainer: Type 1 diabetesoccurs when your body no longer makes insulin, so insulin injections are needed for survival. Type 2 occurs when your body cannot use insulin effectively even though you have some insulin in your body—called insulin resistance.

This means that while the body produces normal or even very high levels of insulin, cells in the body become resistant to it over time so the body does not respond to insulin the way it should. Some people are genetically predisposed to have insulin resistance.

Obesity and a sedentary lifestyle are triggers that can flip the switch from a genetic predisposition for type 2 diabetes to actually developing the disease.

So patients can have the genetic predisposition for insulin resistance, which can be worsened by environmental or physiological factors, such as obesity, high-fat diets and lack of exercise, Dr. Calikoglu says.

This increase in insulin resistance often occurs during puberty. Most children diagnosed with type 2 diabetes are about 12 or 13 years old.

Diabetes is one of the leading risk factors for heart attack and stroke. It also can cause damage to the eyes, including blindness, as well as kidney and liver failure. Diabetes also causes nerve damage that can result in loss of sensation in the feet and wounds. If left untreated, this can lead to amputation.

The Role of Obesity and a Sedentary Lifestyle in Type 2 Diabetes

Nearly 20 percent of children and adolescents have obesity, a percentage than has more than tripled since the 1970s. Researchers think the recent rise in type 2 diabetes is directly related to the rise in obesity rates in the United States, Dr. Mayer-Davis says.

“This really is an epidemic in terms of the increase in occurrence of type 2 diabetes that is largely attributed to obesity in the population,” Dr. Mayer-Davis says.

Dr.Calikoglu says there are some social and economic factors that contribute to this rise in obesity in younger populations.

“First is that kids are exposed to so many advertisements for calorie-rich foods on TV, online and in social media. The second factor is that calorie-rich foods are generally cheaper than healthy foods. A big bag of chips is much cheaper than a bowl of salad,” he says. “The third factor is that American families do not cook at home as much as they used to do. They eat out or order in, and fast food has a high fat content.”

A sedentary lifestyle is another risk factor.

“There is a lot of entertainment that you now can do without needing any other children or friends, such as computer games, video games and social media,” Dr. Calikoglu says, and this has reduced children’s opportunity for exercise.

Preventing Type 2 Diabetes in Children

So what can parents do to help their children avoid this trend?

Start Early

“The most important way to prevent obesity in young children is to have healthy dietary habits beginning early in life and to really encourage physical activity from a young age,” Dr. Mayer-Davis says.

Dr. Ward led thedevelopment of the Nutrition and Physical Activity Self-Assessment for Child Care at UNC, a program that promotes healthy eating and physical activity in young children in child care and preschool settings. She says research has shown that exposing children early to a quality food environment is important in preventing type 2 diabetes.

“Whereas obesity prevention often starts with managing caloric intake (in adults), in young children we need to think about diet quality. And within diet quality, you have to eliminate or minimize unnecessary calories that provide little nutrient value,” she says.

This means giving your children healthy meals and snacks at an early age and avoiding sugary drinks and energy-dense foods. “These are foods that have high sugar and high fat content, such as high-sugar cereals, sugary beverages, french fries and other fast-food meals that are generally providing calories but not a lot of nutrients,” Dr. Mayer-Davis says.

Find Healthy Alternatives

In place of sugary drinks, give your child water that is not artificially sweetened (you can sweeten it yourself naturally, with fruit). Pack carrots or grapes in place of cookies or chips in school lunches. Replace high-sugar cereals with those that have less sugar. Shoot for 6 grams of sugar per serving or less.

“Children can develop a palate for eating healthy foods, and parents and child care staff can support this,” Dr. Ward says.

And because “children will eat what they’re served better in group settings than they do at home,” she says, it’s important to talk to your child care center or preschool about offering healthy food choices.

“Child care programs have an opportunity to play a leading role in helping children improve their palate by exposing them to the less familiar vegetables and other foods that will gradually help them learn more about eating a rainbow of foods,” Dr. Ward says.

The rainbow part is important, and something children can understand: Aiming to eat a colorful variety of foods is a good way to ensure your child is eating a lot of fruits and vegetables and fewer starches and fried foods.

Get Their Bodies Moving

In terms of exercise, Dr. Mayer-Davis says to try to make sure your child gets at least an hour of physical activity almost every day. But any amount of exercise is a step in the right direction. Look for opportunities for physical activity, such as team sports, through your school, church or any other community organization.

Some options include swimming, hiking or riding bicycles. Dr. Mayer-Davis says it’s critical that the activity be fun for the child. “Be sure to ask your child what they would be most interested in doing and consider what will actually work within your family,” she says.

Be a Good Role Model

Model the type of behavior you want for your children. They’re paying attention, even if it doesn’t seem like it.

“It’s really great when parents can be the models for healthy food choices and physical activities with their kids,” Dr. Mayer-Davis says.
“Just model that good behavior or make some of the same changes so that you’re sharing that experience with your kids, especially if there is a family history of diabetes.”


Talk to your child’s doctor if you’re concerned about your child’s weight or risk of type 2 diabetes. If you need a doctor, find one near you.