Rising Pediatric Diabetes Trends in US Medicaid, CHIP Enrollees

Pediatric diabetes is an escalating public health concern in the US, with lifelong health complications and significant societal costs.¹ A new nationwide analysis of Medicaid and Children’s Health Insurance Program (CHIP) enrollees shows that from 2016 to 2021, diabetes prevalence among children steadily increased, with type 2 diabetes rising sharply, particularly among boys and western US residents.

These findings underscore the disproportionate burden on socioeconomically at-risk populations and highlight the urgent need for targeted prevention, early screening, and effective management strategies to mitigate long-term health and economic impacts.

This cross-sectional study is published in JAMA Network Open.

“Despite Medicaid being the single largest source of health insurance coverage for the pediatric population in the US, comprehensive documentation on the prevalence of pediatric diabetes among Medicaid enrollees has been scarce,” wrote the researchers of the study. “This is the first study, to our knowledge, to document prevalence and trends in diabetes among pediatric Medicaid beneficiaries across the US by leveraging TAF data from the Centers for Medicare & Medicaid Services.”

National CDC data show that new cases of both type 1 and type 2 diabetes among young people under 20 have risen, with type 2 diagnoses roughly doubling between 2002 and 2018 and type 1 cases also climbing steadily.² Certain racial and ethnic groups, including Asian/Pacific Islander, Hispanic, and non-Hispanic Black youth, experience the highest annual increases, underscoring the need for focused prevention and management efforts in at-risk populations.

This repeated cross-sectional study analyzed Medicaid and CHIP enrollees 18 years and younger with continuous full-year coverage from 2016 to 2021 across 43 states.¹ Data were drawn from the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files. Researchers assessed the standardized annual prevalence of type 1 diabetes and type 2 diabetes per 1000 enrollees, stratifying trends by age, sex, race and ethnicity, Census region, and urban vs rural residence. Trends over time were evaluated using the Cochran-Armitage test. Seven states and Washington, DC, were excluded due to unstable enrollment proportions or data quality concerns.

Across the study period, the pediatric Medicaid population ranged from approximately 25 million to 30 million enrollees annually. Overall diabetes prevalence increased from 2.73 per 1000 in 2016 to 3.04 per 1000 in 2021, representing an 11.4% relative increase (P < .001). Type 1 diabetes rose modestly from 1.99 to 2.12 per 1,000 (6.5%), while type 2 diabetes showed a sharper increase from 0.74 to 0.92 per 1,000 (24.3%), particularly among boys (48.1% increase) and children in the western US (51.8%). Rural children consistently had higher diabetes prevalence than urban peers, though urban populations experienced a larger relative increase over time (13.3% vs 4.7%).

However, the researchers acknowledged several limitations. This study relied on a claims-based algorithm for identifying pediatric diabetes, which has not been formally validated for Medicaid enrollees. Data gaps include missing race and ethnicity information and a lag in T-MSIS availability. Estimates from 2020-2021 may also reflect pandemic-related effects, including spikes in type 2 diabetes and increased Medicaid enrollment.

Despite these limitations, the researchers believe the study findings demonstrate that pediatric diabetes among Medicaid and CHIP enrollees is steadily increasing, with type 2 diabetes rising particularly rapidly among boys and children in the western US.

“This study highlighted sharp increases in prevalence among subgroups and regions previously considered to be less at risk, namely, males, urban populations, and residents of the West census region,” wrote the researchers. “The findings can help guide resource allocation and public health efforts for prevention, screening, and management of pediatric diabetes.”

References

1. Zhang H, Giannouchos T, Becker D, et al. Pediatric diabetes prevalence among Medicaid beneficiaries. JAMA Netw Open. 2026;9(2):e2560507. doi:10.1001/jamanetworkopen

2. Trends in diabetes among young people. CDC. May 15, 2024. Accessed March 2, 2026. https://www.cdc.gov/diabetes/data-research/research/trends-new-diabetes-cases-young-people.html