Diabetes

Diabetes in United States

United States

Diabetes was the nation’s eighth-leading cause of death in 2020, accounting for 102,188 deaths annually. Those with diabetes are twice as likely to have heart disease or a stroke than those without diabetes. There are three types of diabetes: Type 1, Type 2 and gestational (diabetes while pregnant). Type 2 diabetes accounts for 90%-95% of all cases. 

Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations and blindness among adults. Currently 37.3 million adults are estimated to have diabetes, 8.5 million of whom are undiagnosed. 

Diabetes cost the United States an estimated $327 billion in direct medical costs and lost productivity in 2017.

The prevalence of diabetes is higher among:

• Men compared with women.
• Adults ages 65 and older compared with adults ages 18-64.
• Black and American Indian/Alaska Native adults compared with Asian adults.
• Adults with less than a high school education compared with those with higher levels of education; the prevalence decreases as educational attainment increases.
• Adults with an annual household income less than $25,000 compared with those with higher levels of income.
• Adults living in non-metropolitan areas compared with those in metropolitan areas.

Type 2 diabetes is influenced by risk factors that are amenable to change such as smoking, overweight and obesity, physical inactivity, high blood pressure and high cholesterol. Studies show that the onset of Type 2 diabetes can largely be prevented through weight loss, along with increasing physical activity and improving dietary choices. The National Diabetes Prevention Program, a partnership of public and private organizations working to prevent or delay Type 2 diabetes, includes an evidence-based lifestyle change program that focuses on healthy eating and physical activity. Through the program, people with prediabetes have reduced their risk of developing Type 2 diabetes by 58%. 

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

Diabetes management is critical to prevent complications from the disease. Diabetes may be managed through a healthy diet and physical activity as well as insulin or oral diabetes medicines. More information on diabetes prevention and management can be found on the Centers for Disease Control and Prevention’s (CDC) website and through the American Diabetes Association.

Healthy People 2030 has 15 diabetes-related objectives, including reducing the number of diabetes cases diagnosed yearly and increasing the proportion of people with diabetes who get formal diabetes education.

American Diabetes Association. 2018. “Economic Costs of Diabetes in the U.S. in 2017.” Diabetes Care 41 (5): 917–28. https://doi.org/10.2337/dci18-0007.

Centers for Disease Control and Prevention. 2020. “National Diabetes Statistics Report 2020.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html.

Hamman, Richard F., Rena R. Wing, Sharon L. Edelstein, John M. Lachin, George A. Bray, Linda Delahanty, Mary Hoskin, et al. 2006. “Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes.” Diabetes Care 29 (9): 2102–7. https://doi.org/10.2337/dc06-0560.

National Clinical Care Commission. 2021. “National Clinical Care Commission: Report to Congress on Leveraging Federal Programs to Prevent and Control Diabetes and Its Complications.” Washington, D.C.: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health. https://health.gov/sites/default/files/2022-01/NCCC%20Report%20to%20Congress.pdf.

Schulze, Matthias B., and Frank B. Hu. 2005. “Primary Prevention of Diabetes: What Can Be Done and How Much Can Be Prevented?” Annual Review of Public Health 26 (1): 445–67. https://doi.org/10.1146/annurev.publhealth.26.021304.144532.