Population-based Incidence, Time Trends, and Early Life Factors Associated with Type 2 Diabetes Among Asian American, Native Hawaiian, and Pacific Islander Adolescents and Young Adults

ABSTRACT The number of adolescents and young adults (AYA) with type 2 diabetes (T2D) has risen sharply in parallel with the obesity epidemic in the U.S. If current trends continue, the number of T2D cases among American youth is projected to increase more than seven-fold by 2060. Youth-onset T2D is debilitating, often with a more aggressive clinical presentation compared with adult-onset T2D, and it disproportionately impacts racially and ethnically minoritized youth, contributing to ever-widening health disparities. AYA of Asian American (AsA) and Native Hawaiian and Pacific Islander (NHPI) descent are experiencing the steepest yearly increase in T2D incidence. Unfortunately, current epidemiologic and etiologic studies of AYA T2D are extremely limited due to a lack of population-based studies with diverse samples, and almost no data on T2D in AsA and NHPI youth. Despite their rapidly growing population, little is known about the risk factors and health disparities among AsA and NHPI individuals because they are often understudied; when they are included in research, these subgroups are very often aggregated into a single racial category, masking important social and health differences. Our long-term goal is to better understand the epidemiology of T2D among AYA, with a special focus on AsA and NHPI, identifying high-risk subgroups and modifiable risk factors to inform early detection and design upstream intervention strategies to mitigate health disparities. To fill extant knowledge gaps and inform future guidelines and prevention strategies, we will conduct a large longitudinal cohort study based on a diverse population of over 5 million AYA members at Kaiser Permanente Northern California and Kaiser Permanente Southern California, integrated healthcare organizations with memberships representative of the source population. All members ages 10 to 26 since 2007 will be included. We will use electronic health record data to link diagnosis, laboratory, and other sociodemographic and clinical data to describe ethnic subgroup-specific incidence and temporal trends of youth-onset T2D among AsA and NHPI AYA, and compare with those of other major racial and ethnic groups (Aim 1). We will then investigate maternal and child individual and contextual factors associated with the risks of youth-onset T2D, and examine effect modifications by sex, age groups, and race and ethnicity (Aim 2). This study will critically advance our understanding of the epidemiology and etiology of youth-onset T2D in AsA and NHPI subgroups and provide evidence needed to inform future prevention tools tailored for AsA and NHPI AYA.