New Study Links Childhood Environments to Type 2 Diabetes Risk

Type 2 diabetes (T2D), traditionally viewed as an adult condition, is now increasingly affecting children and adolescents, with alarming statistics emerging from recent research. In the mid-1990s, only 1% to 2% of youth diagnosed with diabetes had T2D. Today, that figure has surged to between 24% and 45%, with the average diagnosis age at approximately 13 years. This rise closely parallels the growing rates of childhood obesity across the globe.

According to a large-scale study conducted by researchers at Florida Atlantic University’s Charles E. Schmidt College of Medicine, the environments where children live significantly impact their risk of developing T2D. The research team analyzed data from the National Survey of Children’s Health covering the period from 2016 to 2020, focusing specifically on children aged five and under, a demographic often overlooked in T2D studies.

The study assessed responses from caregivers of over 174,000 children nationwide, including nearly 50,000 in the early childhood segment. Researchers examined various factors, including diet, physical activity, neighborhood conditions, caregiver health, food security, and participation in government assistance programs. Their aim was to understand how these early life experiences and environments contribute to the risk of developing T2D.

The findings, published in the journal Pediatric Research, indicate that while the overall prevalence of T2D in children under five remained low and stable during the five years studied, the development of the disease appears more closely linked to social and environmental factors than to individual lifestyle choices alone.

Neighborhood Factors and T2D Risk

Certain characteristics of neighborhoods and households emerged as significant indicators of T2D diagnoses. Notably, having a library nearby was associated with higher rates of childhood T2D in both 2016 and 2020. This correlation suggests that urbanized environments, which may encourage more sedentary indoor activities, could contribute to increased diabetes risk.

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

Increases in neighborhood issues such as litter and vandalism were also documented. These environmental concerns escalated between 2016 and 2020, affecting both the overall sample and the younger age group. Other notable findings included the benefits of receiving help from neighbors and the importance of neighborhood walkability, particularly in 2019.

The study also highlighted the role of food assistance programs. In 2017, access to free or reduced-cost meals displayed a connection to neighborhood and household characteristics. Between 2019 and 2020, there was a notable rise in the use of government assistance programs, such as food stamps and free meal plans. While these programs aim to alleviate food insecurity, their effect on nutrition quality is more complex.

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

Strategies for Prevention

The researchers advocate for a comprehensive approach to T2D prevention and early detection, emphasizing the importance of considering environmental factors and food quality. Effective strategies should include improving neighborhood designs and ensuring access to nutritious food options.

Despite these findings, obesity remains the most prevalent risk factor for T2D in children. Those who are significantly overweight are four times more likely to develop the disease by age 25 compared to their peers with a healthy weight. With obesity rates continuing to escalate, particularly among young children, prevention measures are increasingly urgent.

A key focus area is the reduction of sugar-sweetened beverage consumption, which is closely linked to obesity and diabetes 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 small beverage taxes, have achieved slight reductions in consumption within schools, overall intake remains high.

The researchers suggest that more robust policies, including comprehensive bans on sugar-sweetened beverages in schools and increased taxes, may be necessary. Evidence from successful school-based programs demonstrates that improving dietary habits and increasing physical activity among children is feasible with the right support.

Sacca concluded, “The rise in early-onset type 2 diabetes is a growing public health concern. Addressing it requires a comprehensive strategy that includes improving access to nutritious foods, creating healthier neighborhood environments, and investing in policies that promote long-term wellness from the very start of life.”

The study also 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 in FAU’s Department of Medicine.