National Diabetes Audit 2021-22, Young People with Type 2 Diabetes - Overview

• There were 139,255 people under the age of 40 with type 2 diabetes in 2021-22, accounting for 4.8% of all type 2 diabetes cases under the age of 80 in England and Wales (see Table 1). Between 2017-18 and 2021-22, there was a steady year-on-year increase in the number of people with type 2 diabetes across all age groups, with a total percentage increase of 11.6% from 2017-18 to 2021-22. However, a steeper rise was observed in those under the age of 40 with a percentage increase of 18.7% between 2017-18 and 2021-2022 compared to 11.3% in those aged between 40 and 79 years old.

Table 1: Number of people with type 2 diabetes, by age group and audit year, England and Wales, 2017-18 to 2021-22

• A greater proportion of people aged 19-25 years with type 2 diabetes were female (for example 61.3% were female in 2021-22) with equal proportions of males and females in those aged 26-39 years old (for example 50.8% were female in 2021-22). However, males predominated in older age groups (for example. in 2021-22, 58.4% of 40-59 year olds and 57.3% of 60-79 years old were male).
• Young people (aged under 40 years old) with type 2 diabetes were more likely to be from Asian and mixed ethnic groups compared to older people with type 2 diabetes (in 2021-22, 29.6% of 26-39 year olds were from Asian ethnic groups and 2.1% were from mixed ethnic groups compared to 20.9% and 1.7% of 40-59 year olds respectively; see Figure 1). When compared to the national England and Wales picture (1), people from Asian and black ethnic groups were over-represented in younger age groups of people with type 2 diabetes (in 2021-22 (2), 32.0% of 26-39 year olds with type 2 diabetes were from Asian ethnic groups and 7.4% were from black ethnic groups, compared to 11.9% and 4.3% of the national total in this age group respectively; see Figure 2).

• Young people (aged under 40 years old) with type 2 diabetes were more likely to be from deprived areas compared to older people with type 2 diabetes (in 2021-22, 34.4% of people with type 2 diabetes aged 19-25 years old and 34.3% of those aged 26-39 years old lived in the most deprived areas compared to 29.3% and 22.3% of those aged 40-59 and 60-79 years old respectively).
• People with type 2 diabetes aged 19-25 and 26-39 were more likely to be living with obesity, accounting for 77.3% and 74.6% respectively in 2021-22. The proportion of people with type 2 diabetes living with obesity increased over the 5-year period; the proportions in those aged 19-25 and 26-39 rose from 73.4% and 71.7% in 2017-18 to 77.3% and 74.6% in 2021-22 respectively (see Figure 3).

• People with type 2 diabetes under the age of 16 were most likely to be seen by specialist diabetes services in secondary care (89.3% of under 12 year olds and 91.6% of 12-15 year olds). As age increased, young people with type 2 diabetes were more likely to be exclusively under the care of their general practice (GP); 70.1% of those aged 16-18 years old attended specialist secondary care, falling to 30.6% of 19-25 year olds.

See Characteristics and trends of the detailed report for further information.

Notes:

1. National England and Wales population figures based on Census 2021 data. For more information see https://census.gov.uk/.

2. People whose ethnicity was ‘Not stated/Not known’ were excluded from these calculations.

3. People whose BMI category was unknown were excluded from these calculations. How BMI categories have been assigned differ between children (up to 18 years old) and adults. In adults, categories are assigned on BMI ranges and ethnicity group. For children, their BMI is compared to reference values for children of the same sex and similar age that took part in national surveys. See 'Care processes' under definitions in Additional information for further details.

4. Totals may not sum due to disclosure control. See Additional information for more details.

• People aged 19 to 39 years old with type 2 diabetes were less likely to receive all, 8 care processes (1) (26.5% of 19-25 year olds and 34.7% of 26-39 year olds) compared to older people with type 2 diabetes (44.0% and 51.6% of 40-59 and 60-79 year olds respectively; see Figure 4).

• The proportion of people with type 2 diabetes achieving the blood pressure treatment target steadily decreased with age from 67.8% of 12-15 year olds to 58.4% of 26-39 year olds; after which the proportion achieving the treatment target increased with age up to 70.1% of 60-79 year olds.
• Fewer than one-third (28.6%) of people with type 2 diabetes aged 19-25 years old achieved the secondary prevention statin treatment target (2). 
• In people under 40 years old with type 2 diabetes, characteristics most associated with achieving an HbA1c ≤ 58 mmol/mol included being female (odds ratio (OR) is 1.44 when compared to male), being from ethnic groups other than white (for example OR for Asian ethnic groups is 1.23 and OR for black ethnic groups is 1.17 when compared to white ethnic groups), and having a shorter diabetes duration (OR for 2-9 years is 0.60 when compared to duration of less than 2 years) (3). This is supported by additional analysis (4) looking at people under 40 years old with type 2 diabetes, which shows 56.7% of females compared to 49.3% of males, 56.3% of people from Asian ethnic groups and 55.0% of people from black ethnic groups compared to 51.2% of people from white ethnic groups, and 62.8% of people with a diabetes duration of less than 2 years compared to 50.8% of people with a diabetes duration of 2-9 years achieved an HbA1c ≤ 58 mmol/mol.
• In people under 40 years old with type 2 diabetes, characteristics associated with a reduced likelihood of achieving an HbA1c ≤ 58 mmol/mol included being from a more deprived area (most deprived OR is 0.80 when compared to least deprived) and having a longer diabetes duration (OR for 10 years and over is 0.31 when compared to duration of less than 2 years) (3). This is supported by additional analysis (4) looking at people under 40 years old with type 2 diabetes, which shows 51.7% of people from a most deprived area compared to 56.7% of people being from a least deprived area, and 35.2% of people with a diabetes duration of 10 years and over compared to 62.8% of people with a diabetes duration of less than 2 years achieved an HbA1c ≤ 58 mmol/mol.
• In people under 40 years old with type 2 diabetes, having an HbA1c > 86 mmol/mol was associated with black ethnic groups (OR is 1.23 when compared to white ethnic groups), deprivation (most deprived OR is 1.33 when compared to least deprived), longer diabetes duration (OR for 10 years and over is 2.36 when compared to duration of less than 2 years), and lower BMI categories (OR for underweight category is 1.50 when compared to healthy weight category) (3). This is supported by additional analysis (4) looking at people under 40 years old with type 2 diabetes, which shows 20.4% of people from black ethnic groups compared to 17.2% of people from white ethnic groups, 17.7% of people from a most deprived area compared to 14.1% of people being from a least deprived area, 24.7% of people with a diabetes duration of 10 years and over compared to 12.5% of people with a diabetes duration of less than 2 years, and 26.4% of people in the underweight BMI category compared to 19.2% of people in the healthy weight BMI category had an HbA1c > 86 mmol/mol.

See Care processes and treatment targets of the detailed report for further information.

Notes:

1. Diabetes Eye Screening (eye exam/retinopathy) data is not collected for Wales. Therefore, this report is restricted to 8 of the 9 care processes for England and Wales.

1. Care processes assessed based on age:

• Under 12s: HbA1c, BMI, cholesterol, blood pressure and albumin
• 12-18 years: HbA1c, BMI, cholesterol, blood pressure, albumin and foot exam
• 19 years and over: HbA1c, BMI, cholesterol, blood pressure, albumin, foot check, smoking status and creatinine

For example, a person aged 10 would be assessed for the HbA1c, BMI, cholesterol, blood pressure and albumin care processes, but not the foot exam, smoking status and creatinine care processes. Therefore if they received the HbA1c, BMI, cholesterol, blood pressure and albumin care processes then in this analysis they are recorded as having received 'all 8 care processes'.

2. This analysis relates to all people in the cohort, not just people with CVD.

3. Analysis of characteristics associated with HbA1c levels and their respective odds ratios have been derived from logistic regression models. Full analysis from these models can be found in the Care processes and treatment targets page of the detailed report. For information on logistic regression models and odds ratios see Additional information. As the predictive ability of the models are weak (c statistic around 0.6), the findings from these models should be considered in conjunction with the additional analysis in the Open data file accompanying the detailed report.

4. Analysis can be found in the Open data file accompanying the detailed report.

5. For more details on each of the care processes see Additional information.

6. Totals may not sum due to disclosure control. See Additional information for more details.

• People with type 2 diabetes aged 19-25 and 26-39 years old were less likely to be prescribed antihypertensive treatment (for example 15.6% and 27.0% of females respectively) than older people (for example in females 56.2% of 40-59 year olds and 78.4% of 60-79 year olds). Although hypertension is less common at younger ages, it is notable that blood pressure treatment targets are less often achieved in under 40 year olds as a whole when compared to older age groups. Around a quarter of females aged 19-39 years old that might be planning pregnancy were prescribed antihypertensive treatment (26.0%; see Figure 5).

See Antihypertensive treatment and statins of the detailed report for further information.

Notes:

1. Totals may not sum due to disclosure control. See Additional information for more details.