Incidence and Risk Factors of Diagnosed Young-Adult-Onset Type 2 Diabetes in the U.S.: The National Health Interview Survey 2016–2022

OBJECTIVE To estimate the incidence and identify risk factors for diagnosed type 2 diabetes (T2D) among young US adults. Research DESIGN and methods We analyzed 142,884 adults aged 18-79 years with self-reported diabetes type from the cross-sectional National Health Interview Survey in 2016-2022, representing the non-institutionalized US civilian population. Incidence of diagnosed T2D was calculated for three age groups: young-adult-onset (18-44 years), middle-age-onset (45-64 years), and older-adult-onset (65-79 years); the latter two groups were included to highlight the distinct risk factor profile of young-adult-onset T2D. Multivariable logistic regressions were used to identify risk factors for young-adult-onset T2D. RESULTS The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1000 adults (95% CI 2.6-3.5). Minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions had a higher incidence of diagnosed young-adult-onset T2D compared to their counterparts. Lipid-lowering medication use (aOR 13.15, 95% CI 8.85-19.55), antihypertensive medication use (aOR 11.89, 95% CI 7.97-17.73), and obesity (BMI ≥30 vs. <25 kg/m², aOR 10.89, 95% CI 6.69-17.7) were the strongest risk factors for young-adult-onset T2D; these risk factors, along with hypertension, hyperlipidemia, and coronary heart disease were more strongly associated with young-adult-onset T2D compared to later-onset T2D, with up to 4.5 times higher aORs. CONCLUSIONS This study quantified the incidence of diagnosed young-adult-onset T2D in US adults and identified its distinct risk factor profile. Targeted prevention strategies for young-adult-onset T2D are needed for minority and socioeconomically disadvantaged people and those with cardiometabolic diseases.