The SEARCH study ascertained individuals with type 2 diabetes (T2D) diagnosed at <20 years of age at 5 study centers in the US from 2002 to 2018 and calculated annual incidence as number of cases divided by the population <20 years in the catchment area (∼5 million annually based on US Census or health-plan member counts) . We estimated incidence trends using a generalized autoregressive (2-year) moving average model. From annual incidence, we calculated peak age at T2D diagnosis overall population and within period, sex, race and ethnicity strata. Incidence increased from 2002-2009 to 2010-2018 (p<0.0001) ; however, the peak age at diagnosis did not change (16 years; Figure) . Across all years, the peak age at diagnosis was similar between females (16 years [95% CI 15-18]) and males (16 years [16-18]) . The peak age at diagnosis was younger for non-Hispanic Black youth (NHB; 13 years) , while similar for American Indian (AI) , Asian and Pacific Islander (API) , Hispanic (HISP) , and non-Hispanic White (NHW) youth (16 years; Figure) . These data indicate continued increases in T2D incidence across ages associated with the pubertal transition, with a rapid decline following the incidence peak. They also highlight an earlier T2D onset among NHB youth. These results highlight the need for pre-pubertal or early pubertal intervention to mitigate risk of youth-onset T2D.
K. A. Sauder: None. A. Bellatorre: None. J. M. Lawrence: None. J. Divers: None. E. T. Jensen: Consultant; Regeneron Pharmaceuticals Inc. L. E. Wagenknecht: None. A. D. Liese: None. D. Dabelea: None. S. M. Marcovina: None. C. Pihoker: None. K. Reynolds: Research Support; Amgen Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation. A. S. Shah: None. L. M. Dolan: None.
Centers for Disease Control and Prevention and National Institutes of Health