Study Reveals Geography Influences Type 2 Diabetes in Children

Type 2 diabetes (T2D) is increasingly affecting children and adolescents, a trend once thought to be limited to adults. Research from Florida Atlantic University indicates that the environment where a child lives plays a significant role in their risk for developing this condition. Before the mid-1990s, T2D was diagnosed in only 1% to 2% of youth with diabetes. Today, that figure has surged to between 24% and 45%, with the average age of diagnosis around 13 years old.

The study, led by researchers at the Charles E. Schmidt College of Medicine, utilized data from the National Survey of Children’s Health covering the years 2016 to 2020. Researchers specifically focused on a subgroup of children aged birth to five years, an area often overlooked in T2D research. They analyzed responses from caregivers of over 174,000 children nationwide, including nearly 50,000 in the early childhood group. The aim was to explore how various factors, including diet, physical activity, neighborhood conditions, and food security, influence T2D risk.

The findings, published in the journal Pediatric Research, revealed that while the overall prevalence of T2D in children under five remained low, the risk was closely linked to social and environmental factors rather than individual behaviors. Notably, the presence of a library nearby was found to correlate significantly with childhood T2D diagnoses. Libraries are often situated in urban settings that may promote sedentary lifestyles, discouraging outdoor physical activity.

“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,” stated Lea Sacca, Ph.D., the study’s senior author and assistant professor of population health at the Schmidt College of Medicine.

The study also highlighted growing concerns about neighborhood conditions, with caregivers reporting issues such as litter and vandalism. These environmental factors increased between 2016 and 2020 and were observed across all age groups studied. Other notable findings included the positive impact of receiving help from neighbors and the importance of neighborhood walkability, particularly in relation to T2D risk.

Further analysis indicated that access to free or reduced-cost meals was similarly associated with neighborhood characteristics. From 2019 to 2020, there was a significant rise in participation in government assistance programs like food stamps, free meal plans, and cash support. While these initiatives aim to alleviate food insecurity, their effects on nutrition quality are complex. Previous research suggests that reliance on food assistance can lead to poorer dietary choices, often resulting in higher consumption of processed foods high in sugar and fat.

“While this finding could suggest improved access to food, previous research shows that relying on food assistance doesn’t always equate to better nutrition,” noted Sacca. Children from food-insecure households frequently experience poorer blood sugar control and higher hospitalization rates. Some studies even indicate that participants in programs like SNAP may have worse diet quality than their similarly low-income counterparts who do not participate.

The research team emphasizes that effective prevention and early detection strategies for T2D must take into account both environmental factors and food quality. Addressing neighborhood designs and ensuring access to nutritious food options are crucial for long-term impact. Despite these findings, obesity remains the most significant risk factor for T2D in children. Children who are significantly overweight are four times more likely to develop T2D by age 25 compared to their healthy-weight peers.

With obesity rates continuing to rise, especially among young children, there is an urgent need for preventive measures. A particular focus should be on reducing the consumption of sugar-sweetened beverages, which are strongly linked to both obesity and T2D risk. Alarmingly, nearly 70% of children aged two to five consume sugar-sweetened beverages daily.

While some school-based initiatives, such as vending machine restrictions and minor beverage taxes, have led to slight reductions in consumption during school hours, overall intake levels remain concerningly high. The researchers advocate for more robust policies, including comprehensive bans in schools and increased taxation on sugary drinks.

Evidence from successful school-based programs demonstrates that improving children’s dietary habits and physical activity levels is achievable with appropriate support. “The rise in early-onset type 2 diabetes is a growing public health concern,” concluded Sacca. “Addressing it requires a comprehensive strategy that includes improving access to nutritious foods, enhancing neighborhood environments, and investing in policies that promote long-term wellness from the very start of life.”

This study involved contributions from FAU medical students, 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 at FAU’s Department of Medicine.