Diabetes is taking a harsher-than-recognized toll on young adults, who struggle with blood sugar control and end up in hospital care more often than older adults with the chronic disease.

The finding, reported Monday by the Minnesota Department of Health, didn't surprise doctors who work daily with young and old patients, but it suggests that health officials may need to rethink the state's diabetes support programs, which tend to target people 45 or older.

"We need to tailor our care and outreach to address the needs of younger adults with diabetes," said state Health Commissioner Jan Malcolm. "These people have long lives ahead of them, and it is important to ensure that diabetes is managed well so they can live those years in good health."

Adults 44 and younger comprise only 16 percent of Minnesota's diabetes population. But a study by Health Department and University of Minnesota researchers found that they are nearly three times more likely than adults aged 45-64 to need hospital admissions for their diseases and four times more likely than those 65 and older.

The U.S. Centers for Disease Control and Prevention reported the results in its Preventing Chronic Disease journal.

Diabetes occurs when the body fails to produce or respond to insulin, a hormone involved in the metabolism and regulation of blood sugar. It is a leading cause of stroke, heart and kidney disease and eye and circulatory problems.

The study included people with type 1 diabetes, whose bodies develop little or no insulin and are often diagnosed in childhood, and people with type 2 diabetes, whose bodies grow resistant to insulin over time.

That might have tilted the results against younger people, because type 1 diabetes is often found in younger people and is more difficult to manage. But all young adults in the study struggled to meet target blood sugar levels; only 25.4 percent of those with type 1 met recommended levels, compared to 46.3 percent with type 2.

"Neither of them are hitting the mark," said Renee Kidney, a lead author of the study.

Two decades ago, type 2 diabetes was rarely diagnosed in young adults and children. But it has emerged as a serious health concern because of its link to the growing U.S. obesity rate. Research has found that it is more severe in young adults and causes them to need injections of synthetic insulin sooner than those who develop the disease at older ages.

Diabetes also can be harder to manage for young adults, who lead less predictable lives as they find careers, change jobs, meet spouses and have children, Kidney said.

Young adults with diabetes also are more likely to smoke, which can exacerbate symptoms, and suffer depression, the study found.

Young adults might feel despair at being diagnosed with a lifelong disease and guilt over failing to "manage" diabetes, said Dr. Amy Criego, a Park Nicollet endocrinologist who was not involved in the study.

"It's really easy for young people to feel judged by the labels that are placed on them when it comes to their diabetes management," she said.

The rising cost of insulin might also be a more severe challenge for young adults because they have less access to health insurance, compared to senior citizens, she added.

Criego was optimistic. The study was based on clinic and survey records from 2015 and earlier. Automatic, wearable insulin pumps have become more common since then along with phone- and watch-enabled diabetes apps.

"Glucose management is more difficult in that age group, just because of less structure in their environments and their lifestyles," she said, "but also they are more savvy with technology. So it maybe balances out."

Jeremy Olson • 612-673-7744