Diabetes in United States

United States

Diabetes is a chronic health condition that disrupts the body's ability to use or make insulin, a hormone that allows sugars to enter cells and be used for energy. Without insulin or proper insulin response, sugar accumulates in the bloodstream, which can lead to serious health problems like heart disease, vision loss and kidney disease. Diabetes was the seventh-leading cause of death in the United States in 2023. 

There are three types of diabetes:

• Approximately 90%-95% of diabetes cases in the U.S. are Type 2 diabetes, which occurs when the body cannot use insulin appropriately to regulate blood sugar levels.
• Much is still unknown about what causes Type 1 diabetes, but it is thought to be the result of an autoimmune reaction that destroys the insulin-producing cells in the body. Approximately 5%-10% of diabetes cases in the U.S. are Type 1.
• Gestational diabetes can develop during pregnancy due to hormonal and physiological changes. While gestational diabetes typically resolves after giving birth, it can increase the risk of developing Type 2 diabetes later in life for both mother and child.

Additionally, prediabetes may be diagnosed when blood sugar levels are elevated but not high enough for a Type 2 diabetes diagnosis. Prediabetes can lead to increased risk of developing Type 2 diabetes, heart disease and stroke. 

Diabetes costs the U.S. an estimated $413 billion annually in direct medical costs and lost work.

According to America’s Health Rankings analysis, the prevalence of diabetes is higher among:

• Adults age 65 and older, who have a prevalence more than six times that of adults ages 18-44.
• Black and American Indian/Alaska Native adults compared with white, Asian and multiracial adults.
• Adults with less than a high school education compared with those who have higher levels of education.
• Adults with an annual household income less than $25,000, who have a prevalence three times that of adults with incomes of $150,000 or more.
• Adults living in nonmetropolitan areas compared with those in metropolitan areas.
• Adults who have difficulty with self-care or mobility, both of whom have a prevalence more than three times higher than that of adults without a disability.
• Straight adults compared with lesbian, gay, bisexual and queer (LGBQ+) adults.
• Adults who have served in the U.S. armed forces compared with those who have not served.

Type 2 diabetes is influenced by many risk factors that are amenable to change, such as smoking, overweight and obesity, physical inactivity and high blood pressure. Eating a healthy diet, getting enough regular physical activity and losing weight if you are overweight can all help reduce your risk for Type 2 and gestational diabetes. The National Diabetes Prevention Program includes an evidence-based lifestyle change program focusing on healthy eating and physical activity.

Currently, there are no known ways to prevent Type 1 diabetes; however, it can be managed by following a doctor’s recommendations for a healthy lifestyle, controlling blood sugar and getting regular health checkups. 

Diabetes management is critical to preventing complications. Diabetes can be managed through a healthy diet and physical activity, as well as insulin or oral diabetes medications. More information on diabetes prevention and management can be found on the Centers for Disease Control and Prevention’s diabetes webpage and on the American Diabetes Association's website. 

The U.S. Preventive Services Task Force recommends screening for prediabetes and Type 2 diabetes among adults ages 35-70 who are overweight or have obesity. Additionally, the Community Preventive Services Task Force has identified interventions to prevent and manage diabetes, including intensive lifestyle interventions, mobile phone applications and team-based care for patients with Type 2 diabetes.

The National Clinical Care Commission report from the U.S. Department of Health and Human Services discusses population-level strategies for federal programs to prevent and control diabetes. The report emphasizes the need for federal agencies to promote drinking water over sugar-sweetened beverages, support breastfeeding and expand housing opportunities for low-income individuals and families in walkable areas with access to healthy food and green space.

Healthy People 2030 has many diabetes-related objectives, including:

• Reducing the number of diabetes cases diagnosed yearly.
• Reducing the death rate in adults with diabetes.
• Increasing the proportion of people with diabetes who get formal diabetes education.
• Reducing the proportion of adults who don’t know they have prediabetes.

Herman, William H., Dean Schillinger, Shari Bolen, John M. Boltri, Ann Bullock, William Chong, Paul R. Conlin, et al. “The National Clinical Care Commission Report to Congress: Recommendations to Better Leverage Federal Policies and Programs to Prevent and Control Diabetes.” Diabetes Care 46, no. 2 (February 1, 2023): 255–61. https://doi.org/10.2337/dc22-1587.

Murphy, Sherry L., Kenneth D. Kochanek, Jiaquan Xu, and Elizabeth Arias. Mortality in the United States, 2023. NCHS Data Brief No. 521. Hyattsville, MD: National Center for Health Statistics, December 19, 2024.https://doi.org/10.15620/cdc/170564.