CDC funded research models a 700 percent rise by 2060, not explained by obesity, consistent with dramatic increases in vaping and nicotine-diabetes link

by Clark Miller

Published March 26, 2023

As summarized here – 

The U.S. Centers for Disease Control and Prevention (CDC) on Thursday warned a surge of diabetes among young Americans is on the horizon, saying diagnoses for the population are expected to soar in the coming decades.

The CDC cited a new study published in the journal Diabetes Care, which models a nearly 700 percent increase of Type 2 diabetes diagnoses in Americans under the age of 20 through 2060, if an expected upward trend continues. 

Type 1 diabetes could also increase 65 percent among young Americans in the next 40 years following the same trend.

Debra Houry, the CDC’s acting principal deputy director, said the “new research should serve as a wake-up call for all of us.”


There’s a big surge happening and predicted to continue for kids in development of Type 2 diabetes. 

And it’s not all about obesity. In fact, incidence of juvenile prediabetes appears to have become less about obesity over past years. 

As explained in a recent post – 

As predicted, large increases among youth in use of nicotine by inhalation as use of e-cigarettes (vaping) has surged are associated with newly reported doubling of teen prediabetes prevalence over the same period. That was foreseeable based on the direct link between nicotine and risk of diabetes onset, as explained here at A Critical Discourse beginning in August of 2018 and in posts repeatedly after that. The new report follows publication of the same predictable results for adults four weeks ago, described here.

Prediabetes prevalence nearly doubled among U.S. youth from 1999 to 2018, national data indicated.

According to National Health and Nutrition Examination Survey (NHANES) data on over 6,500 youth, the prevalence of prediabetes increased from 11.6% in 1999-2002 to 28.2% in 2015-2018, Junxiu Liu, PhD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in JAMA Pediatrics.

. . .  Some of the sharpest spikes in prevalence occurred in youth with obesity. Increases across BMI groups form 1999-2002 to 2015-2018 were:

Underweight or normal weight: 9.42% to 24.3%

Overweight: 15.3% to 27.5%

Obesity: 18.2% to 40.4%

This dramatic spike in prediabetes prevalence was apparent for youth of all ages. Specifically, those ages 12 to 15 saw a rise in prediabetes prevalence from 13.1% in 1999-2002 up to 30.8% by 2015-2018. As for older teens ages 16 to 19, these rates likewise more than doubled from 10% up to 25.6%.

That’s a clear distortion of the results.

For kids with obesity, the prevalence about doubled, that is, increased by a factor of 2.2. For overweight kids, prevalence was close to doubling, a factor of 1.8. 

An exact doubling would be an increase by a factor of 2.0. Right. 

And for kids underweight or normal weight, the increase in prevalence was greater than for overweight or obese kids, 2.6, or a factor of slightly more than two and a half. 

That is, the spike in prevalence of prediabetes for youth over a period of surging use of nicotine by vaping was not accounted for by obesity. The increase was about as much for overweight as for obese (a higher BMI than overweight) and was, notably, highest for kids who were normal weight or underweight. 

youth vaping

One more time, just to be clear. Over a period of rapid expansion of use of nicotine by young people – nicotine established as having a direct causal relationship to insulin resistance – prediabetes surged in young people, not just obese young people. The gain in prevalence (9.4. percent to 24.3 percent) for underweight or normal weight – a factor of 2.6 – was greater than for overweight kids (1.8, about a doubling) and obese kids, about the same as overweight – 2.2. 

And as summarized here, the report published in JAMA Pediatrics found that the increases stayed true across socioeconomic and other variables such as weight, household food security, race, and age”. 

The direct link is to nictine, as described here and  in multiple posts

And that link is predicted to have had large effects over past years that vaping nicotine has increased. 

Overall nicotine use by youth has increased due largely to the rise in use of e-cigarettes and similar products to administer nicotine, , especially over past years and decade. 

Contributing to overall increases in use of nicotine by youth, that increase has instead of replacing use of nicotine by use of traditional cigarettes, been linked to a clear shift – decades of large decreases in use of combustible cigarettes stalled or even reversed over the period of surging e-cig take-up, the evidence pointing to increased incidence of nicotine use initiated with vaping tied to resurgence of traditional cigarette use

But sharp upward trends in prevalence of youth use of new device types to inhale nicotine and increases in frequency of use do not capture – grossly underestimate – total exposure to nicotine due to increases in concentration, = dose, of nicotine used in the new devices. 

That is, trends in actual use of nicotine have been magnified by concomitant rise in use of higher concentrations of nicotine, necessarily providing elevated levels of delivered amounts. 

In 2022, over 2.5 million middle and high school students reported using e-cigarettes, according to the National Youth Tobacco Survey, with nearly half (46%) of high schoolers who vape doing so near daily, putting them on a trajectory for a potential lifetime of nicotine addiction.

As e-cigarettes have expanded to include a diverse array of flavors and device types, nicotine strengths have been climbing. The average nicotine concentration in e-cigarette products increased from 2.10% to 4.34% between 2013 and 2018 alone, a 106.7% increase.  The popular JUUL devices were originally introduced in 2015 with a 5% nicotine salt pod, prompting JUUL competitors to begin offering nicotine salt concentrations as high as 7% in what has been called a “nicotine arms race.”

That’s all troubling, or should be, and is largely ignored.

And the focus or narrowing of concern to diagnosed or modeled prevalence of juvenile diabetes is a dangerous distortion and minimization of risk of harm to the juvenile population affected.

Because the evidence for surging prediabetes in youth and its link to nicotine and vaping is as strong or stronger than that for diabetes.

And because of these recent warnings:

From a recent post –

Back to the MEDPAGE Today piece – 

There is increasing evidence to support that even before its progression to type 2 diabetes, prediabetes independently is a toxic metabolic state causing an increased risk of cardiovascular disease and mortality. It is important to note that pediatric type 2 diabetes is a significantly different disease from adult type 2 diabetes in that it has a very aggressive course that leads to rapid beta cell failure and insulin dependence.

And this – 

Elevated blood glucose poses a threat to the eyes even prior to a diabetes diagnosis, according to a Dutch population study.

In cross-sectional data of Maastricht Study participants, a more adverse glucose metabolism status was linked with a lower z score of corneal nerve fiber measures compared with a normal status (-0.14, 95% CI -0.25 to -0.04, P for trend=0.001), reported Sara Mokhtar, a PhD student at Maastricht University Medical Center in the Netherlands, and colleaguesThis corneal nerve damage was seen even in those with prediabetes (-0.08, 95% CI -0.17 to 0.03), they noted at the European Association for the Study of Diabetes(EASD) meeting.

“That implies that the corneal nerve damage is a process that starts before the onset of type 2 diabetes,” Mokhtar said during her presentation.

The most grim and harm-predicting concern

is more fundamental and intractable: that the risk of continuing uncontrolled surges in compulsive use of food and nicotine by youth, increasing risk of prediabetes and diabetes with high risk of morbidity and mortality – both representing compulsive use of substances to attempt to manage inner states driven by complex, modifiable family, psychosocial, psychological, and developmental stressors and forces – is entrusted for care and treatment to the medical profession. That is, entrusted to practitioners entirely out of scope of practice for formulating and providing understanding for therapeutic individual, family, and public health responses to those non-medical issues.

Just as they have been entirely out of scope of practice for addressing the non-medical conditions of depression, compulsive use of opioids and all other mood-altering substances, and the non-medical condition of common chronic pain. There is a theme here, among these American, medically-treated and lethal afflictions  – of malpractice by practice out of scope of competence, of illness and death, of epidemic and public health crisis.

That was all predictable – as predictable as if individuals trained in neurology were entrusted to understand and formulate treatment and public health response for the conditions of fear, insecurity, hopelessness, aggression, stress, social desperation, discord and unrest driving illness. As predictable as are negative outcomes for kids needing the effective family, psychosocial and other prevention and treatment strategies required to reduce risk of compulsive nicotine and food use, if their needs are entrusted to medical care.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”

– Pierre Bourdieu  Outline of a Theory of Practice (1972)

In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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