A Troubling Rise of Uncontrolled Diabetes in Young Persons

CDC recently told us that diagnoses of diabetes have been rising – very much in line with the decades-long rise in obesity prevalence. As if that news were not sufficiently troubling, a research letter in JAMA this week tells us that adequate control of diabetes is going down. Most of that decline is happening in younger persons, adults between the ages 20 to 44. This rise of uncontrolled diabetes in young persons is troubling indeed.

The authors, Kosuke Inoue and colleagues, explain succinctly why this matters:

“The increase of 1% in mean HbA1c levels and 20% decrease in glycemic control would increase the lifetime risk of cardiovascular events.”

An Artifact of the Pandemic?

Speculating on the cause for this finding, Inoue et al raise the possibility that the pandemic may have played a role. It might explain why they observed diabetes control worsening for young adults, but not older adults:

“A prior national study found that younger adults with diabetes were significantly more likely to report disruptions in health care access and difficulty accessing diabetes medications than their older counterparts during the pandemic. In contrast, older adults have near-universal insurance coverage under Medicare, which may have helped maintain access to care and medications.”

An Unnecessary Loss of Health

All of this represents a terrible missed opportunity. We have better tools for preventing type 2 diabetes in young persons, for putting it into remission, and keeping it under control. That would mean fewer heart attacks, strokes, and many other complications of uncontrolled diabetes down the road.

But right now, our health systems are not so good at delivering this care. The cost of the drugs, especially the advanced GLP-1 agonists, are quite high. Smart health policies need to bring those costs down and ensure that the people who need this care can get it.

Those who say they want to make America healthy have an obvious opportunity to do so.

Click here for the research letter in JAMA and here for further perspective on it.

The Monk by the Sea, painting by Caspar David Friedrich / Wikimedia Commons

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March 1, 2025