Pediatric Diabetes Prevalence Among Medicaid Beneficiaries

Pediatric diabetes, an increasing public health concern in the US, is associated with lifelong health complications and substantial societal costs. The burden is particularly severe among socioeconomically at-risk populations. Medicaid and the Children's Health Insurance Program (CHIP) insure 49% of all youths in the US, disproportionately covering socioeconomically at-risk populations. However, national data on prevalence and trends in pediatric diabetes among Medicaid and CHIP enrollees are lacking.

To provide comprehensive nationwide estimates and trends in the prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) among Medicaid and CHIP pediatric enrollees from 2016 to 2021 and to assess variation across demographic and geographic subpopulations.

This repeated cross-sectional study used 2016 to 2021 Transformed Medicaid Statistical Information System Analytical Files to study Medicaid and CHIP enrollees aged 18 years and younger with continuous full-year enrollment in each study year across 43 states (7 states and Washington, DC, were excluded due to unstable continuous enrollment proportions or other data quality issues). Trends were assessed using the Cochran-Armitage test.

Demographic (age, sex, race, and ethnicity) and geographic (census region and urban vs rural) characteristics.

Main outcomes were standardized annual prevalence of T1D and T2D per 1000 enrollees. Subgroup trends were stratified by age, sex, race and ethnicity, region, and urbanicity.

Approximately 25 million to 30 million youths were included in the study each year. Across all study years, enrollees aged 0 to 6 years and 7 to 12 years each accounted for approximately 35% of the Medicaid pediatric population (8 887 176 of 25 537 653 [34.9%] and 9 069 241 [35.6%] in 2016 and 10 025 946 [33.2%] and 10 308 534 of 30 324 022 [34.1%] in 2021, respectively), whereas those aged 13 to 18 years represented approximately 30% (7 484 682 [29.4%] in 2016 and 9 905 058 [32.8%] in 2021). The proportion of male enrollees was slightly higher than female enrollees (13 074 795 [51.2%] males vs 12 452 685 [48.8%] females in 2016 and 15 528 719 [51.2%] vs 14 794 520 [48.8%] in 2021). From 2016 to 2021, pediatric diabetes prevalence among Medicaid-enrolled youths increased from 2.73 to 3.04 per 1000 enrollees (11.4% relative increase; P < .001). T1D increased from 1.99 to 2.12 (6.5%) and T2D from 0.74 to 0.92 (24.3%). T2D increases were especially pronounced among males (48.1%) and residents of the western US (51.8%). Rural residents had a higher prevalence of diabetes across all study years but a substantially lower relative increase compared with urban residents (4.7% vs 13.3%).

In this cross-sectional study of Medicaid-enrolled youths, the prevalence of pediatric diabetes steadily increased, underscoring an increasing public health challenge. The sharp increase in T2D highlights the urgent need for targeted prevention, screening, and management strategies to mitigate long-term health and economic consequences.