Health inequities in adolescents with Down syndrome: overlooked risk of type 2 diabetes mellitus

Abstract Background Down syndrome (DS), the most common aneuploidy worldwide, is associated with metabolic anomalies affecting insulin and glucose regulation, increasing the risk of type 2 diabetes mellitus (T2DM). Despite this, adolescents with DS are often excluded from public health strategies, especially in low-resource settings where early screening and tailored interventions are limited. This study explores the association between DS and T2DM risk in adolescents in Veracruz, México, and highlights the urgent need to adapt inclusive prevention frameworks in public health systems. Methods A cross-sectional, prospective study was conducted in Veracruz, México; between September and December 2024, including adolescents aged 12-18. Those with diabetes or using medications that alter glucose or insulin metabolism were excluded. DS was the main independent variable. Dependent variables included T2DM risk, acanthosis nigricans (AN), high BMI, abdominal obesity, low physical activity, and poor diet, assessed via FINDRISC-A, PAQ-A and KIDMED (Cronbach's alpha: 0.84, 0.67, 0.79, respectively). Non-probability sampling was used. After ethics approval, informed consent was obtained from parents and adolescents. Data were analyzed using SPSS v.27. Results 122 adolescents were included, 21 (17.2%) had DS. Overall, 25 participants (36.3%) had moderate to high T2DM risk. DS was significantly associated with elevated T2DM risk (OR: 5.91; 95% CI: 2.09-16.71; p < 0.001), AN (OR: 19.8; 95% CI: 3.65-107.3; p < 0.001), and abdominal obesity (OR: 3.17; 95% CI: 1.17-8.57; p = 0.01). No significant associations were found with physical activity or diet (p > 0.05). Conclusions Adolescents with DS show a clear metabolic vulnerability, underscoring the need for inclusive screening and early prevention. Public health systems must adapt to address atypical risk profiles and reduce health inequities for youth with disabilities. Key messages • Early detection of metabolic risk in adolescents with Down syndrome is crucial to prevent the early onset of type 2 diabetes and reduce long-term health disparities. • Public health strategies must recognize Down syndrome as a metabolic risk group and implement inclusive, community-based screening and prevention programs.