Rise in early-onset type 2 diabetes among young women in England

Young women are leading a worrying increase in early-onset type 2 diabetes (T2D) diagnoses in England, according to a new analysis led by researchers from Imperial College London, UK. In a population study of T2D in England, the researchers found a clear generational divide, with diagnosis rates rising rapidly among younger adults, particularly women, while declining in older age groups.

The research, published in Lancet Regional Health Europe, is the first to examine trends in new diagnoses of T2D across the entire English population while stratifying analyses by age, sex and ethnicity. The researchers analysed English National Diabetes Audit data and calculated age-standardized incidence rates for adults with type 2 diabetes by age, sex and ethnicity from 2011 to 2024.

Overall trends in diabetes incidence have usually appeared stable or increasing, but these new data show that while incidence is falling in older adults - who make up the largest proportion of new diagnoses - it is increasing rapidly in people younger than 40.

This is especially worrying, the researchers explain, because type 2 diabetes diagnosed at a younger age leads to longer lifetime exposure to the disease, earlier death and a greater risk of serious complications, including poor pregnancy outcomes in women. They say current type 2 diabetes prevention strategies may be working less well in younger generations.

In addition, the new analysis clearly shows that younger women younger than 40 are driving this rising trend. Discussion of rising levels of type 2 diabetes has tended to focus on ethnic minority populations, but these data show that the increase in early-onset type 2 diabetes among younger people is not confined to ethnic minority populations. The analysis shows that the rise is particularly noticeable in white, Asian and Black women ages 20–29, and in white women ages 30–39.

"Much of the discussion around rising type 2 diabetes in younger people has focused on ethnic minority groups,” said Dr Shivani Misra, from the Department of Metabolism, Digestion and Reproduction at Imperial College London, who led the study. “While these ethnic groups are disproportionately affected by early-onset type 2 diabetes, we now see that incidence is also increasing in white populations, showing that this public health challenge is broadening across the generation."

The study also identified a dramatic shift in average body weight at the time of diagnosis. While obesity is already well-established as the major risk factor for type 2 diabetes, researchers found that body mass index (BMI) at diagnosis has been rising more rapidly in younger adults than in older adults.

The increase in BMI over time among younger people diagnosed with type 2 diabetes was approximately double that seen in older adults. This suggests that successive generations of younger adults are developing type 2 diabetes with increasingly severe obesity.

Among some groups, the figures were particularly striking. White women diagnosed at younger ages had average BMIs approaching 40 kg/m², a level classified as severe obesity.

"We have known for a long time that obesity is linked to type 2 diabetes, but what is new from this study is the scale of the change occurring in younger adults. We think that the earlier onset of severe obesity in young people is increasing their type 2 diabetes risk in early life and pulling down their age at diagnosis,” Misra added. "This is really worrying given the poor health outcomes from early-onset type 2 diabetes. As numbers increase, we need to think about implementing effective treatments as early as possible."

The analysis shows that older adults are not experiencing as large an increase in BMI at diagnosis, but the reasons remain unclear. However, the study did not examine weight trends in the general population, and further research is needed.

The authors say the findings highlight an urgent need to rethink approaches to type 2 diabetes and obesity prevention, with greater focus on reaching younger adults.

Potential strategies could include earlier identification of people at risk, encouraging greater participation in diabetes prevention programs at younger ages, earlier use of effective weight-management treatments such as GLP-1 medicines, and targeted weight-management support for people with severe obesity, for example, intensive lifestyle interventions or bariatric surgery. However, researchers stress that population-level prevention remains crucial.

"There are many factors in society today that can contribute to someone developing obesity, from the widespread availability and marketing of unhealthy foods to increasingly sedentary lifestyles, and young people appear to be particularly vulnerable to today's obesogenic environment,” Misra concluded. "If we are serious about reducing the future burden of type 2 diabetes, we need stronger public health measures that create healthier environments and help prevent type 2 diabetes from developing in the first place."

The authors also urge that age-stratified analyses should become a routine part of assessing type 2 diabetes trends, as national averages may conceal important shifts occurring within specific population groups.

"The rise in type 2 diabetes among younger adults is deeply concerning. Any diagnosis of type 2 diabetes is serious, but it can be more aggressive in younger people, increasing the risk of devastating complications and cutting lives short,” said Helen Kirrane, head of policy, campaigns and mobilisation at Diabetes UK. "Type 2 diabetes is a complex condition without a single cause. That's why further action needs to be taken by the government, including restricting the promotion of unhealthy food and creating environments that support healthier lives. As trends change, so must approaches to prevention and care. We're committed to advancing research that identifies those most at risk and tailors support their needs. This includes younger adults, who are underserved by current approaches, and women who have had gestational diabetes."

The findings were reported in the paper, ‘Trends in type 2 diabetes incidence and BMI at diagnosis by age, sex, and ethnicity, 2011–2024: a population-based analysis of the English National Diabetes Audit’, published in The Lancet Regional Health - Europe. To access this paper, please click here