Type 2 Diabetes Mellitus in Adolescents
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Type 2 Diabetes Mellitus in Adolescents
Chantel Moore
DePaul University College of Nursing
NSG 401 Nursing Research I
Sheila Townson, DNP, MSN, MS RN, RD
August 4, 2023
Type 2 Diabetes Mellitus in Adolescents
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Type 2 Diabetes Mellitus in Adolescents
Background and Significance
Type 2 Diabetes Mellitus (T2DM) is a growing crisis among adolescents and young
people in the United States. Traditionally, T2DM has been known to have an adult onset.
However, according to Rao and Jensen (2020), the incidence of youth-onset type 2 diabetes has
increased at an annual rate of around 4.8% in the last two decades. The United States is among
the leading countries in youth-onset type 2 diabetes, with a prevalence of around 212 cases per
100,000 people (Lynch et al., 2020). The increase in childhood T2DM was noted in the mid1990s, notably in several countries such as the United States, Canada, Japan, Austria, and
Germany (Koren & Levitsky, 2021). The increasing rates of adolescents with type 2 diabetes
mellitus, this is a worrying trend in young people’s health, and there is a need for action to
reverse these trends.
The pathophysiology of different diabetes conditions is unique. T2DM develops because
of decreased insulin sensitivity. In young people, decreased sensitivity is addressed by increased
insulin secretion (Sam et al., 2021). In cases when the young person’s β-cells cannot produce
enough insulin to compensate, there is an imbalance in glucose homeostasis, resulting in
potential prediabetes and type 2 diabetes if the deterioration of β-cells continues further
(Arslanian et al., 2018). This process is not typical in young people but is the pathophysiology of
youth-onset diabetes. Factors that could reduce insulin sensitivity and deteriorate the function of
β-cells are the main factors leading to type 2 diabetes mellitus.
Numerous factors are contributing to diabetes in adolescents. The Centers for Disease
Control and Prevention (CDC), identifies that more than a third of young people are overweight,
Type 2 Diabetes Mellitus in Adolescents
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with some as young as 10 years old facing the risk of type 2 diabetes mellitus. Other than weight,
physical activity also matters. Less active children are more likely to develop obesity and
diabetes mellitus. The CDC (n.d.) also identifies that during early teenage, hormonal changes
may make it challenging for the body to use insulin and this is especially common in girls than
boys. The risk of diabetes mellitus in teenagers is also affected by genetics. Maternal obesity and
gestational diabetes mellitus are predictive factors of obesity and youth-onset diabetes in
adolescents (Arslanian et al., 2018). Various genetic and environmental factors may be causing
the rise in rates of adolescent type 2 diabetes mellitus.
Type 2 diabetes mellitus has traditionally been known as an adult-onset chronic
condition, but there has been a recent increase in youth-onset cases. This chronic condition is
now a growing crisis threatening the health of young people. Addressing health trends requires
an in-depth understanding of the causes of these trends and how they affect the population.
Archibald et al. (2021) identify that the experiences of youths with type 2 diabetes mellitus are
an area that has not been well researched. Further research on the growing crisis’s experiences
and factors can help build interventions to address the crisis.
Problem Statement
There is a growing crisis of early-onset T2DM affecting adolescents, and there is not
enough knowledge on the causes of this crisis and appropriate resources to address it. Type 2
diabetes mellitus is a chronic condition that has traditionally been prevalent among adults.
However, in the last three decades, there has been a sudden increase in adolescents developing
chronic conditions (Archibald et al., 2021; Koren & Levitsky, 2021; Lynch et al., 2020). This
trend is concerning since it outlines a relatively new population health issue that has not been
Type 2 Diabetes Mellitus in Adolescents
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studied for long. Addressing the issue in adolescents presents a challenge because there is scarce
information on the cause of this trend and appropriate resources to support this population. While
much of the research on type 2 diabetes mellitus has been on adult populations, little has been
done on adolescents, which creates a challenge in addressing the increasing rates of adolescenceonset diabetes (Arslanian et al., 2018). Knowledge of the factors that may have led to the shift in
type 2 diabetes mellitus is essential in developing interventions to address the current crisis.
Further research on causes of increasing type 2 diabetes mellitus in adolescents will promote
population health interventions and policy.
Purpose Statement
The purpose of this literature review is to identify the causes of the increasing rates of
adolescence-onset type 2 diabetes mellitus and resources that can be deployed to address the
growing crisis.
Research Questions
1. Why is the incidence of type 2 diabetes mellitus increasing among adolescents?
2. What resources can be used to reduce the incidence of type 2 diabetes mellitus among
adolescents?
Type 2 Diabetes Mellitus in Adolescents
Conceptual Framework
Figure 1
Conceptual Framework for Diabetes Mellitus Incidence
Note: Adapted from Black, 2002, p. 544
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Type 2 Diabetes Mellitus in Adolescents
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Methods
Research Design
The research design applied for this study was an integrative review approach. According
to Whittemore and Knafl (2005), the first step is identifying the focus problem. The problem was
defined as an increased adolescent-onset type 2 diabetes mellitus. A literature search was then
conducted. Three databases were used to search for appropriate literature. Data evaluation and
analysis are then conducted per Whittemore and Knafl’s (2005) recommendations. Authenticity
and methodological quality were used to evaluate the articles obtained. The research then
included data analysis through theoretical and content analysis methods. The process of an
integrative review was applied as the research design.
Literature Search Strategy
The search strategy includes a search of peer-reviewed articles from three databases. The
search databases include PubMed, Google Scholar, and Web of Science. The three have peerreviewed scholarly articles covering a broad scope of nursing and medical topics. The search
keywords include ‘type 2 diabetes mellitus,’ ‘adolescent-onset,’ ‘insulin resistance,’ ‘early
onset,’ ‘youth,’ and ‘glycemic control.’ The search aims to determine the factors associated with
an increase in type 2 diabetes in adolescents; hence the search keywords are appropriate.
Literature Search Limitations and Inclusion/Exclusion Criteria
The search is limited to the most current literature and peer-reviewed sources. The
timeframe for the search is the last ten years (articles published from 2012 to 2022). The search
strategy will be limited to peer-reviewed research articles written in English and published
within the last ten years. In addition, the search will be limited to peer-reviewed research articles
only. Duplicate articles from different databases will be excluded. Any article not published in
Type 2 Diabetes Mellitus in Adolescents
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English will also be excluded from the review. Both primary and secondary data analyses will be
included, provided the article includes research methodology.
Study Selection and Review Diagram
Figure 2
Diagram of Review Process and Study Selection
Note: Adapted from Shimpuku & Norr, 2011, p. 3.
Type 2 Diabetes Mellitus in Adolescents
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Data Synthesis and Analysis
The articles sought from WoS, PubMed, and Google Scholar were compiled in a
comprehensive data table with the article title, author and year, research design and
methodology, and findings captured. Duplicate articles from all databases were excluded from
the table, and then the inclusion/exclusion criteria were used to narrow down the search. Quality
appraisal was conducted by evaluating the rigor of research articles and cross-checking the peerreviews of each article. A clear description of the research methodology was sought as a criterion
for excluding articles. In the final articles selected, content analysis was used to identify patterns
in the subject matter.
Results
Lifestyle Factors and Obesity
With the increased incidence of type 2 diabetes mellitus (T2DM) in children and
adolescents, the most common factors identified in most studies are lifestyle factors and obesity
increase in the population. Family history of diabetes, high body mass index (BMI), a sedentary
lifestyle in the homes of teenagers, racial minority, and a high waist-to-hip ratio are predictors of
adolescence-onset diabetes (Yu et al., 2016; Candler et al., 2018; Bjerregaard et al., 2018).
Moreover, childhood obesity, if it continues into puberty, has been associated with an increased
risk of T2DM (Bjerregaard et al., 2018). Obesity is a chronic condition associated with long-term
health outcomes that predict diabetes. Lifestyle changes in children has also been identified as a
crucial determinant of diabetes prevention (TODAY Study Group, 2012). Lifestyle factors other
than being physically active include healthy diet with the TODAY Study Group (2012)
identifying dietary factors as major contributors to insulin resistance in adolescents as well. This
Type 2 Diabetes Mellitus in Adolescents
means more active children and adolescents are less likely to have adolescence- and adult-onset
T2DM.
Inflammatory Biomarkers
Inflammatory biomarkers have also been identified as associated with adolescence-onset
T2DM. Inflammatory biomarkers are substances in the body useful in assessing the presence or
absence of an active inflammation process in the body. A study by Reinehr et al. (2016)
compared adolescents with and without T2DM and found that among those with the condition,
there was a higher rate of inflammatory biomarkers, adipokines, and hepatokines. In another
study by Janem et al. (2017), it was established that there is an increased risk of having T2DM
among adolescents with inflammatory biomarkers in their saliva, indicator of poor oral health.
The overall health outcomes of adolescents are linked to the risk of diabetes.
Antipsychotics
An emerging concern from the research is what has been named ‘drug-induced
hyperglycemia’. This is a situation of high blood glucose associated with drug use in children.
Antipsychotic medications have received the most attention. Bobo et al. (2013) found that
children and adolescents who were using antipsychotics were three times more likely to be
diagnosed with T2DM than those who do not use the medications. Similarly, Sun et al. (2021)
reported a significant increased risk of T2DM diagnosis in children taking selective serotonin
reuptake inhibitors (SSRI). However, in the latter, the risk is reported as smaller than previously
thought. Nevertheless, the two studies report an increased risk of T2DM with anti-psychotic
medications.
Interventions to Prevent Adolescence-Onset T2DM
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Type 2 Diabetes Mellitus in Adolescents
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Researchers have focused on various approaches to reducing obesity and diabetes risks in
youth as the two have been linked. Weight loss has been proposed as the primary approach and
this includes the reduction of number of hours spent in sedentary living and an increase in active
lifestyle (Smart et al., 2014). Other than weight loss, dieting strategies have been identified as
effective. More so, dieting strategies that reduce the amount of carbohydrate foods and sugars
have been associated with reduced incidence of obesity and hyperglycemia (Gow et al., 2016).
Studies on diabetes management have focused more on how adolescents already diagnosed with
the chronic condition can manage their own health and reduce the risk of complications. The
findings from this study have highlighted the key determinants of diabetes risk and health
outcomes in children and adolescents as well as the methods used to reduce the risk of
complications and manage diabetes in those already diagnosed with the condition.
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Systematic Review of Literature Table
Table 1: Systematic Review of Literature Table
Article/Journal
Antipsychotics and the Risk of
Type 2 Diabetes Mellitus in
Children and Youth/JAMA
Psychiatry.
Inflammatory Markers in
Obese Adolescents with Type
2 Diabetes and Their
Relationship to Hepatokines
and Adipokines/ The Journal
of Pediatrics
Author/Year
Bobo et al. 2013
Reinehr et al. 2016
Database/Keywords
Google Scholar; youth,
children, type 2 diabetes
mellitus
PubMed; adolescents, type 2
diabetes mellitus
Research Design
Retrospective cohort study
Cross-sectional study
Level of Evidence (see
article in Readings)
Level IV
Level IV
Study Aim/Purpose
To determine whether
antipsychotics use in
adolescence and youth
increases the risk of type 2
diabetes mellitus.
Statewide hospital discharge
database and Medicaid program
with 28,858 children
To evaluate inflammatory
markers, adipokines, and
hepatokines in adolescents
with and without type 2
diabetes mellitus
Adolescents aged 12-18 years;
74 predominantly Caucasian
adolescents with obesity
Methods/Study
Appraisal
Synthesis Methods*
Cox regression model to
evaluate correlation
Evaluation of the levels of
inflammatory biomarkers and
adipokines and hepatokines/
analysis of variance
Study tool/instrument
validity/reliability*
Primary Outcome
Measures/Results
Not indicated
Not relevant
Newly diagnosed cases of
diabetes; antipsychotics users
had 3x increased risk of type 2
Prevalence of biomarkers/
inflammatory biomarkers were
more common in adolescents
Population/Sample size
Criteria/Power
Type 2 Diabetes Mellitus in Adolescents
diabetes within the first year of
follow-up
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with type 2 diabetes than those
without
Conclusions/Implications Prescribing antipsychotics to
children may increase the risk
of type 2 diabetes mellitus;
reducing rates of antipsychotic
medications prescriptions may
adjust prevalence of type 2
diabetes mellitus
Strengths/Limitations
Strengths: This is a state-wide
primary research article with
supported by hospital discharge
data
Limitation: There is no clear
causal connection between
antipsychotics and diabetes
management
There is a link between
adipokines and hepatokines
and chronic inflammation.
Funding Source
None
Comments
*Optional
Agency for Healthcare
Research and Quality, Centers
for Education and Research on
Therapeutics cooperative
agreement
Pharmacodynamics in
childhood may affect risk factor
for diabetes type 2
Strengths: Comparing
adolescents with diabetes and
those without
Limitation: The study did not
include a diverse population
and hence has limited
generalizability
Inflammatory biomarkers are a
risk factor for diabetes in
adolescents
Type 2 Diabetes Mellitus in Adolescents
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Article/Journal
Initiating characteristics of
early-onset type 2 diabetes
mellitus in Chinese patients/
Chinese Medical Journal
Continuing rise of type 2
diabetes incidence in children
and young people in the
UK/ Diabetic Medicine
Author/Year
Yu et al. 2016
Candler et al. 2018
Database/Keywords
WoS/ Early-onset, type 2
diabetes mellitus
PubMed
Research Design
Cross-sectional study
Prospective cohort study
Level of Evidence (see
article in Readings)
Level IV
Level IV
Study Aim/Purpose
To evaluate the characteristics To determine the incidence of
and demographics of patients
type 2 diabetes in children aged
with early onset type 2 diabetes
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