T2DM Prevalence Rising in Native American Youth

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.

A recent worldwide survey found the United States to have the highest reported prevalence of type 2 diabetes mellitus (T2DM) among young people aged 10 to 19 years. Research on the prevalence of the disease among Indigenous populations is scarce, however, leaving these individuals at a potentially greater risk.

The estimated prevalence of T2DM has nearly doubled over the past 2 decades, with cases per 1000 youths aged 10 to 19 years increasing from 0.34 in 2001 to 0.46 in 2009 to 0.67 in 2017, a relative increase of 95.3% over 16 years. In 2012, the SEARCH study of youth-onset T2DM found American Indians and non-Hispanic Black individuals had the highest incidence (46.5/100,000/year in American Indians and 32.6/100,000/year in non-Hispanic Black individuals), compared with non-Hispanic White individuals (3.9/100,000/year).

About 28,000 US youth aged < 20 years had T2DM in 2017, a figure expected to reach 48,000 in 2060 based on increasing prevalence and incidence rates. Assuming the trends observed between 2002 and 2017 continue, an estimated 220,000 young people will have T2DM. 

However, the lack of recent research of T2DM in young indigenous populations may have masked a serious problem among Native Americans. A 2025 literature review of 49 studies call it a “type 2 diabetes crisis” among Indigenous communities; not because of the disease, but due to high rates of complications. Though Indigenous peoples are estimated to inhabit > 90 countries and collectively represent > 370 million people, the studies included in the review involved individuals from 6 countries and 2 self-governing states (US, Canada, Australia, Aotearoa New Zealand, Nauru, Argentina, the Cook Islands, and Niue) and at least 45 Indigenous populations after search criteria were satisfied. Data were derived from population-based screening and health databases, including from 432 IHS facilities and 6 IHS regions.

Of the study populations, 27 (75%) reported diabetes prevalence above 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0 to 4 per 1000 at age < 10 years; 0 to 44 per 1000 at age 10 to 19 years; and 0 to 64 per 1000 at age 15 to 25 years. 

In young adults aged 15 to 25 years, prevalence was highest in Akimel O’odham and Tohono O’odham Peoples from the Gila River Indian Community in Arizona. Among children aged < 10 years, the highest prevalence was reported in Cherokee Nation children. Some groups reported no diabetes, such as the Northern Plains Indians from Montana and Wyoming.

Statistics showing the speed of expanding prevalence were particularly notable. For Akimel O’odham and Tohono O’odham Indian youth, diabetes prevalence increased more than eightfold over 2 decades (particularly in those aged < 15).

A 2021 study of 500 participants who were diagnosed with T2DM in youth were followed for a mean of 13 years. By the time they were 26, 67.5% had hypertension, 51.6% had dyslipidemia, 54.8% had diabetic kidney disease, and 32.4% had nerve disease. 

Indigenous North American children may also have an even greater risk for later complications. A Canadian study found that among Canadian First Nations Peoples the incidence of end-stage kidney disease was 2.8 times higher and the mortality rate was double that of non-Indigenous people with youth-onset T2DM despite similar age at diagnosis and duration of disease. 

To combat the steady increase of T2DM prevalence among Indigenous youth, researchers advise “urgent action” to improve data equity through the inclusion of Indigenous populations in health surveillance, routine disaggregation by Indigenous status, and culturally safe research partnerships led by Indigenous communities. Standardized age group classifications, age- and gender-specific reporting, and assessment of comorbid obesity are essential, they add, to define health care needs and identify regions that would benefit from enhanced early detection and management.