P-245: Early prevalence shift from type 1 towards type 2 diabetes across adolescence and young adulthood with marked racial and ethnic differences: the PAPAYA study
S Srinivasan, A J Karter, J Acker, S Daredia, C J Huang, J Deardorff, J Liu, S Chen, S Negriff, A M Kanaya, A KuboAbstract
Introduction
The growing burden of type 2 diabetes (T2D) in adolescents and young adults (AYAs) has highlighted changing diabetes patterns at younger ages.
Objectives
Our objectives were to determine changes in prevalence of type 1 diabetes (T1D) and T2D across the adolescent and young adult ages and examine differences across racial and ethnic groups.
Methods
We analyzed electronic health record data from 783,801 adolescents and young adults (AYA) aged 10–30 years with prevalent diabetes in 2024 from Kaiser Permanente Northern California (KPNC) in the United States as part of the Predictors of Adverse Cardiometabolic Problems in Adolescents and Young Adults (PAPAYA) Study. Diabetes type was classified using a validated algorithm. We calculated the proportion of T1D and T2D cases by age and race/ethnicity across four age categories (10-15, 16-20, 21-25 and 26-30 years).
Results
The prevalence of T1D and T2D among KPNC members aged 10–30 years was 4.32 and 6.56 per 1,000 respectively. Overall, T1D was more common than T2D (3.28 vs 1.04/1000, respectively) in early adolescence, but T2D increased steadily with age, becoming the most common type by ages 21-25 (T1D: 6.67 vs T2D: 4.97/1000) (Fig 1a). Earlier T2D predominance was more evident in non-White groups (Fig 1b–1i>).
Conclusions
In this diverse, real-world AYA cohort, we observed an early and progressive relative rise in T2D that differed markedly by race and ethnicity. These findings underscore the need for screening and clinical strategies that reflect this shifting epidemiology.