Diabetes

Diabetes in United States

United States

Diabetes was the nation’s eighth-leading cause of death in 2021, accounting for more than 100,000 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, an increase of 26% from the 2012 estimate of $245 billion.

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

• Men compared with women.
• Adults ages 65 and older compared with adults ages 18-64.
• American Indian/Alaska Native and Black adults compared with Asian adults.
• Adults with less than a high school education compared with those with higher levels of education.
• 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.
• Adults who have difficulty with self-care compared with adults without a disability.
• Straight adults compared with 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, high blood pressure and high cholesterol. Strategies to prevent or delay Type 2 diabetes include losing weight for those who are overweight, eating a healthy diet and getting enough regular physical activity.

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 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 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 diabetes webpage and through the American Diabetes Association. 

The U.S. Preventive Services Task Force recommends screening for prediabetes and Type 2 diabetes among adults ages 35-70 who have overweight or obesity. Additionally, the Community Preventive Services Task Force has identified interventions to prevent or 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 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.

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.

American Diabetes Association. “Economic Costs of Diabetes in the U.S. in 2017.” Diabetes Care 41, no. 5 (May 1, 2018): 917–28. https://doi.org/10.2337/dci18-0007.