Diabetes Rate by State in US 2025
The diabetes epidemic continues to surge across the United States, affecting millions of Americans and creating significant health and economic burdens for states nationwide. Understanding the geographic distribution of diabetes prevalence helps policymakers, healthcare providers, and communities develop targeted interventions to combat this chronic disease. The latest data from the Centers for Disease Control and Prevention reveals striking disparities in diabetes rates across different states, with some regions experiencing prevalence rates more than twice as high as others.
According to the most recent CDC National Diabetes Statistics Report, approximately 38.4 million Americans have diabetes, representing 11.6 percent of the total U.S. population. Among adults aged 18 years and older, the prevalence reaches 14.7 percent, meaning roughly 1 in 7 adults lives with this chronic condition. More concerning is that 8.7 million adults remain undiagnosed, accounting for 22.8 percent of all adults with diabetes. The geographic variation in diabetes prevalence reflects complex interactions between socioeconomic factors, lifestyle behaviors, healthcare access, and environmental conditions that differ substantially from state to state.
Key Diabetes Facts and Latest Statistics for US States in 2025
| Key Diabetes Fact | Statistic | Year |
|---|---|---|
| Total Americans with Diabetes | 38.4 million people (11.6%) | 2024 |
| Adult Diabetes Prevalence | 38.1 million adults (14.7%) | 2024 |
| Undiagnosed Diabetes Cases | 8.7 million adults (22.8%) | 2024 |
| Highest State Prevalence | West Virginia at 18.2% | 2024 |
| Second Highest State | Mississippi at 17.0% | 2024 |
| Third Highest State | Louisiana at 16.1% | 2024 |
| Lowest State Prevalence | District of Columbia at 7.4% | 2024 |
| Second Lowest State | Utah at 7.8% | 2024 |
| Third Lowest State | Colorado at 8.6% | 2024 |
| Prediabetes Prevalence | 97.6 million adults (38.0%) | 2024 |
| Seniors with Prediabetes | 27.2 million aged 65+ (48.8%) | 2024 |
| Rural vs Urban Prevalence | 14.3% rural vs 11.2% urban | 2021 |
| Men vs Women Prevalence | 12.9% men vs 9.7% women | 2024 |
| Annual Economic Cost | $412.9 billion nationally | 2024 |
| Direct Medical Costs | $335 billion | 2024 |
| Indirect Costs (Productivity) | $305 billion | 2024 |
Data Source: CDC National Diabetes Statistics Report 2024, CDC Behavioral Risk Factor Surveillance System (BRFSS) 2024, American Diabetes Association 2024
The data reveals profound geographical disparities in diabetes prevalence across American states. West Virginia leads the nation with an alarming 18.2 percent of adults diagnosed with diabetes, followed closely by Mississippi at 17.0 percent and Louisiana at 16.1 percent. These southern and Appalachian states consistently rank among the highest for diabetes burden, reflecting complex interplays of poverty, limited healthcare access, food insecurity, and higher rates of obesity. Conversely, the District of Columbia reports the lowest prevalence at just 7.4 percent, with Utah at 7.8 percent and Colorado at 8.6 percent rounding out the states with the lowest diabetes rates.
The rural-urban divide in diabetes prevalence has emerged as a critical health disparity, with rural areas experiencing 14.3 percent prevalence compared to 11.2 percent in urban areas—a difference of more than 3 percentage points that translates to millions of affected individuals. Gender disparities also persist nationwide, as men demonstrate significantly higher diabetes rates at 12.9 percent compared to women at 9.7 percent. Perhaps most concerning is the prediabetes epidemic, with nearly 98 million American adults living with this condition, and among those aged 65 and older, almost half (48.8 percent) have prediabetes, placing them at substantially elevated risk for developing full diabetes within the next decade without intervention.
States with Highest Diabetes Rates in the US 2025
| State Rank | State | Diabetes Prevalence (%) | Estimated Adults Affected |
|---|---|---|---|
| 1 | West Virginia | 18.2% | Approximately 280,000 |
| 2 | Mississippi | 17.0% | Approximately 405,000 |
| 3 | Louisiana | 16.1% | Approximately 580,000 |
| 4 | Alabama | 15.7% | Approximately 615,000 |
| 5 | South Carolina | 14.9% | Approximately 615,000 |
| 6 | Arkansas | 14.5% | Approximately 350,000 |
| 7 | Tennessee | 14.5% | Approximately 790,000 |
| 8 | Delaware | 13.3% | Approximately 104,000 |
| 9 | Indiana | 13.2% | Approximately 695,000 |
| 10 | Ohio | 13.2% | Approximately 1,220,000 |
| 11 | Georgia | 12.7% | Approximately 1,065,000 |
| 12 | Texas | 12.7% | Approximately 2,930,000 |
Data Source: CDC BRFSS 2024, Statista Health Statistics 2024, KFF State Health Facts 2024
The southeastern United States bears a disproportionate diabetes burden, with the highest concentration of affected states forming what researchers call the “Diabetes Belt.” West Virginia’s 18.2 percent prevalence rate represents the nation’s highest diabetes burden, meaning nearly 1 in 5 adults in the state lives with this chronic condition. This translates to approximately 280,000 West Virginia residents managing diabetes daily, straining the state’s healthcare infrastructure and economic resources. Mississippi follows closely at 17.0 percent, affecting roughly 405,000 adults across the state, while Louisiana’s 16.1 percent rate impacts about 580,000 individuals.
The clustering of high-prevalence states in the Southeast reflects multiple interconnected risk factors including elevated obesity rates, physical inactivity, lower educational attainment, higher poverty levels, limited access to preventive healthcare, and cultural dietary patterns high in processed foods and added sugars. Alabama’s 15.7 percent prevalence affects approximately 615,000 adults, while South Carolina at 14.9 percent and both Arkansas and Tennessee at 14.5 percent each demonstrate how the diabetes crisis pervades this geographic region. These states face compounded challenges as diabetes prevalence strongly correlates with other chronic conditions including heart disease, stroke, and kidney failure, creating cascading healthcare demands and costs.
States with Lowest Diabetes Rates in the US 2025
| State Rank | State | Diabetes Prevalence (%) | Estimated Adults Affected |
|---|---|---|---|
| 1 | District of Columbia | 7.4% | Approximately 43,000 |
| 2 | Utah | 7.8% | Approximately 195,000 |
| 3 | Colorado | 8.6% | Approximately 400,000 |
| 4 | Alaska | 8.7% | Approximately 47,000 |
| 5 | Vermont | 9.3% | Approximately 47,000 |
| 6 | Montana | 9.4% | Approximately 80,000 |
| 7 | North Dakota | 9.5% | Approximately 57,000 |
| 8 | Washington | 9.6% | Approximately 600,000 |
| 9 | New Hampshire | 9.8% | Approximately 108,000 |
| 10 | Massachusetts | 9.8% | Approximately 545,000 |
| 11 | Idaho | 9.8% | Approximately 140,000 |
| 12 | Connecticut | 9.9% | Approximately 280,000 |
Data Source: CDC BRFSS 2024, Statista Health Statistics 2024, KFF State Health Facts 2024
The states with the lowest diabetes prevalence demonstrate that effective prevention and health promotion strategies can substantially reduce diabetes burden within populations. The District of Columbia leads with just 7.4 percent prevalence, meaning fewer than 1 in 13 adults lives with diabetes, affecting approximately 43,000 residents. Utah follows at 7.8 percent, with about 195,000 adults diagnosed, while Colorado reports 8.6 percent prevalence, impacting roughly 400,000 individuals. These lower rates persist despite growing national trends because these regions demonstrate higher levels of physical activity, better access to preventive healthcare, lower obesity rates, and populations with higher educational attainment.
Colorado and Utah particularly exemplify how active lifestyles and outdoor recreation culture contribute to lower diabetes rates, as residents in these mountain states engage in substantially more physical activity than the national average. Alaska at 8.7 percent and Vermont at 9.3 percent similarly benefit from populations that prioritize physical fitness and have greater access to fresh, healthy foods. Montana, North Dakota, Washington, New Hampshire, Massachusetts, Idaho, and Connecticut all maintain prevalence rates below 10 percent, demonstrating that diabetes is not an inevitable consequence of modern American life but rather a largely preventable condition when communities prioritize health-promoting environments, policies, and behaviors.
Diabetes Prevalence by Age Groups in the US 2025
| Age Group | Total Diabetes Prevalence | Diagnosed Diabetes | Undiagnosed Diabetes |
|---|---|---|---|
| Ages 20-39 | 3.6% | 2.8% | 0.8% |
| Ages 40-59 | 17.7% | 14.3% | 3.4% |
| Ages 60 and Older | 27.3% | 23.1% | 4.2% |
| Ages 65 and Older | 29.2% | 24.8% | 4.4% |
| All Adults 18+ | 15.8% | 11.3% | 4.5% |
| All Adults 20+ | 14.3% (age-adjusted) | 10.1% (age-adjusted) | 4.2% (age-adjusted) |
Data Source: CDC National Health and Nutrition Examination Survey (NHANES) August 2021-August 2023, CDC National Diabetes Statistics Report 2024
Age represents one of the strongest risk factors for diabetes development, with prevalence increasing dramatically across the lifespan. Young adults aged 20 to 39 years experience just 3.6 percent total diabetes prevalence, with 2.8 percent diagnosed and 0.8 percent undiagnosed, reflecting the relatively low diabetes burden in younger populations. However, diabetes prevalence surges nearly fivefold to 17.7 percent among adults aged 40 to 59, with 14.3 percent diagnosed and 3.4 percent remaining undiagnosed, demonstrating how midlife represents a critical period for diabetes onset as metabolic changes, weight gain, and declining physical activity converge.
The diabetes crisis intensifies further among older Americans, with adults aged 60 and older experiencing 27.3 percent total prevalence—meaning more than 1 in 4 seniors lives with diabetes. Within this group, 23.1 percent have diagnosed diabetes while 4.2 percent remain undiagnosed. Among those aged 65 and older specifically, prevalence reaches 29.2 percent, affecting nearly 3 in 10 older adults and creating substantial healthcare demands as these individuals simultaneously manage multiple chronic conditions, require more intensive medical management, and face elevated risks for diabetes-related complications including cardiovascular disease, kidney failure, vision loss, and neuropathy.
Diabetes Prevalence by Race and Ethnicity in the US 2025
| Race/Ethnicity | Diabetes Prevalence | Comparison to National Average |
|---|---|---|
| American Indian/Alaska Native | 13.6% | 43% higher than average |
| Non-Hispanic Black | 12.1% | 27% higher than average |
| Hispanic/Latino (All) | 11.7% | 23% higher than average |
| Non-Hispanic Asian | 9.1% | 4% lower than average |
| Non-Hispanic White | 6.9% | 27% lower than average |
| National Average (All Adults) | 9.5% | Baseline |
Data Source: CDC National Diabetes Statistics Report 2024, CDC Health Disparities Data 2024
Profound racial and ethnic disparities in diabetes prevalence underscore how social determinants of health, systemic inequities, and differential access to care drive health outcomes across American communities. American Indian and Alaska Native populations experience the highest diabetes burden at 13.6 percent, representing a 43 percent higher prevalence compared to the national average and reflecting historical trauma, forced displacement from traditional lands and diets, limited economic opportunities, and inadequate healthcare infrastructure in many tribal communities. Non-Hispanic Black adults face 12.1 percent prevalence, a 27 percent elevation above average, driven by complex factors including residential segregation, food deserts, discrimination in healthcare settings, higher stress levels from systemic racism, and limited access to preventive services.
Hispanic and Latino populations demonstrate 11.7 percent prevalence, or 23 percent above the national average, though substantial variation exists among Hispanic subgroups with Mexican Americans and Puerto Ricans experiencing particularly elevated rates. Non-Hispanic Asian Americans show 9.1 percent prevalence, slightly 4 percent lower than average, though this aggregate figure masks considerable heterogeneity among Asian ethnic subgroups, with South Asian Americans experiencing significantly higher diabetes rates than East Asian populations. Non-Hispanic White adults have the lowest prevalence at 6.9 percent, representing 27 percent below average, reflecting greater access to healthcare resources, higher socioeconomic status on average, and residence in neighborhoods with better health-promoting infrastructure.
Diabetes Prevalence by Education and Income Levels in the US 2025
| Socioeconomic Factor | Category | Diabetes Prevalence |
|---|---|---|
| Education Level | Less than High School | 13.1% |
| Education Level | High School Graduate | 9.1% |
| Education Level | More than High School | 6.9% |
| Income Level (Men) | Below 500% Federal Poverty Level | Higher rates |
| Income Level (Men) | Above 500% Federal Poverty Level | 6.3% |
| Income Level (Women) | Below 500% Federal Poverty Level | Higher rates |
| Income Level (Women) | Above 500% Federal Poverty Level | 3.9% |
| Geographic Setting | Nonmetropolitan (Rural) | 14.3% |
| Geographic Setting | Metropolitan (Urban) | 11.2% |
Data Source: CDC National Diabetes Statistics Report 2024, CDC Social Determinants of Health Data 2024
Educational attainment serves as a powerful predictor of diabetes risk, with adults having less than a high school education experiencing 13.1 percent prevalence—nearly double the 6.9 percent rate observed among those with more than a high school education. This educational gradient reflects how schooling influences health literacy, employment opportunities, income levels, access to healthcare, neighborhood quality, and ability to navigate complex healthcare systems. Adults with only a high school education demonstrate intermediate prevalence at 9.1 percent, illustrating the dose-response relationship between education and diabetes risk.
Income disparities prove equally stark, with men earning above 500 percent of the federal poverty level showing just 6.3 percent prevalence compared to substantially higher rates among lower-income men, while women above 500 percent poverty experience remarkably low 3.9 percent prevalence versus much higher rates among women with lower incomes. These patterns demonstrate how financial resources enable healthier food purchases, gym memberships, medical care, preventive screenings, stress reduction, and residence in safer neighborhoods with better infrastructure for physical activity. The rural-urban divide shows 14.3 percent prevalence in nonmetropolitan areas versus 11.2 percent in metropolitan regions, reflecting how rural Americans face limited access to healthcare providers, fewer grocery stores with fresh produce, greater distances to fitness facilities, and higher poverty rates.
Diabetes Prevalence by Body Weight Status in the US 2025
| Body Mass Index Category | Total Diabetes Prevalence | Diagnosed Diabetes | Undiagnosed Diabetes |
|---|---|---|---|
| Underweight (BMI <18.5) | 4.8% | 3.9% | 0.9% |
| Normal Weight (BMI 18.5-24.9) | 6.9% | 4.9% | 2.0% |
| Overweight (BMI 25.0-29.9) | 14.7% | 10.8% | 3.9% |
| Obese (BMI ≥30.0) | 25.6% | 18.8% | 6.8% |
| Severely Obese (BMI ≥40.0) | Higher than 25.6% | Substantially elevated | Substantially elevated |
Data Source: CDC NHANES August 2021-August 2023, CDC National Diabetes Statistics Report 2024
Body weight status represents the single most modifiable risk factor for type 2 diabetes, with obesity dramatically elevating diabetes risk through mechanisms including insulin resistance, chronic inflammation, altered fat metabolism, and pancreatic beta cell dysfunction. Adults with obesity (BMI 30 or higher) experience 25.6 percent total diabetes prevalence—nearly 4 times higher than the 6.9 percent rate among normal weight individuals (BMI 18.5-24.9). Within the obese category, diagnosed diabetes affects 18.8 percent while 6.8 percent remain undiagnosed, and prevalence climbs even higher among those with severe obesity (BMI 40 or higher).
Overweight adults (BMI 25.0-29.9) show 14.7 percent total prevalence, with 10.8 percent diagnosed and 3.9 percent undiagnosed, representing more than double the rate observed in normal weight populations and demonstrating how even modest excess weight substantially increases diabetes risk. Underweight adults (BMI below 18.5) experience just 4.8 percent prevalence, though this group’s low numbers partly reflect underlying health conditions that cause weight loss rather than protective effects of low weight. Data reveal that among all adults aged 18 and older with diagnosed diabetes during 2015-2018, an overwhelming 89.9 percent were classified as overweight or obese, underscoring how excess body weight drives the diabetes epidemic and highlighting why weight management through diet and physical activity represents the cornerstone of diabetes prevention strategies.
Prediabetes Prevalence in the US 2025
| Population Category | Prediabetes Prevalence | Number of Americans |
|---|---|---|
| All Adults 18+ | 38.0% | 97.6 million |
| Adults 65+ | 48.8% | 27.2 million |
| Men | Higher than women | Not specified |
| Women | Lower than men | Not specified |
| Awareness Rate | Less than 20% | Only 19.3% aware |
| Reversal Potential | Up to 58% with intervention | With lifestyle changes |
Data Source: CDC National Diabetes Statistics Report 2024, National Diabetes Prevention Program 2024
The prediabetes crisis represents an underrecognized public health emergency, with 97.6 million American adults—38.0 percent of the adult population—living with prediabetes, defined as blood glucose levels higher than normal but not yet high enough to be classified as diabetes. This staggering prevalence means more than 1 in 3 adults sits on the precipice of developing full diabetes within the next decade without intervention. Among those aged 65 and older, prediabetes affects a shocking 48.8 percent, meaning nearly half of all seniors (27.2 million individuals) have this condition, placing them at substantially elevated risk for diabetes, cardiovascular disease, nerve damage, and other complications even before they develop clinical diabetes.
Perhaps most concerning, research shows that fewer than 20 percent of people with prediabetes actually know they have it, with only 19.3 percent aware of their elevated blood glucose status. This awareness gap means tens of millions of Americans remain unaware they’re at high risk and miss critical opportunities for intervention. However, the good news is that prediabetes can be reversed through lifestyle modifications, with evidence from the National Diabetes Prevention Program demonstrating that adults who lost 5 to 7 percent of body weight and engaged in 150 minutes of weekly physical activity reduced their risk of developing type 2 diabetes by 58 percent, and among those aged 60 and older, the risk reduction reached an impressive 71 percent, proving that prediabetes represents a crucial intervention window where simple lifestyle changes can prevent or delay diabetes onset and its associated complications.
Economic Burden of Diabetes by State in the US 2025
| Economic Category | National Cost | State Range |
|---|---|---|
| Total Diabetes Cost | $412.9 billion | $842 million (Wyoming) to $80.9 billion (California) |
| Direct Medical Costs | $335 billion | 52% of total costs nationally |
| Indirect Costs (Productivity Loss) | $305 billion | 48% of total costs nationally |
| Lost Workdays (Absenteeism) | $11.0 billion | 35 million lost workdays |
| Reduced Productivity (Presenteeism) | $58.8 billion | 184 million lost workdays |
| Inability to Work | $76 billion | 993,000 individuals |
| Mortality Costs | $147.8 billion | 288,000 deaths |
| Per Person Annual Medical Costs | $19,736 total | $12,022 directly for diabetes |
| Cost Multiplier vs Non-Diabetic | 2.6 times higher | Medical expenses |
Data Source: American Diabetes Association Economic Costs Study 2024, Diabetes Care Journal 2024, CDC Economic Analysis 2024
Diabetes imposes a staggering economic burden on American society, families, and healthcare systems, with total national costs reaching $412.9 billion in 2024, comprising $335 billion in direct medical costs and $305 billion in indirect costs from reduced productivity and premature mortality. At the state level, costs range from $842 million in Wyoming (the smallest state burden) to $80.9 billion in California (the largest), with a median state cost of $8.2 billion, reflecting both state population sizes and diabetes prevalence rates.
The human toll translates directly to economic losses, with diabetes causing 184 million lost workdays annually from presenteeism (reduced productivity while at work) costing $58.8 billion, 35 million lost workdays from absenteeism totaling $11.0 billion, and rendering 993,000 individuals completely unable to work, costing $76 billion. Diabetes-related mortality claims 288,000 American lives annually, creating $147.8 billion in mortality costs ranging from $181 million in Vermont (381 deaths) to $17.6 billion in California (27,000 deaths). On an individual level, people with diabetes face average annual medical expenses of $19,736, with $12,022 spent directly on diabetes care, representing 2.6 times higher medical spending compared to people without diabetes, illustrating how diabetes impoverishes families while simultaneously straining healthcare budgets at local, state, and national levels.
Diabetes Complications and Mortality in the US 2025
| Complication Type | Statistic | Impact |
|---|---|---|
| Cardiovascular Disease Risk | 1.5 to 2 times higher | Leading cause of death |
| Emergency Room Visits | 16.8 million visits | Adults 18+ in 2020 |
| Hospital Discharges | 7.86 million discharges | With diabetes diagnosis |
| Major Cardiovascular Disease | 1.68 million discharges | With both diabetes and CVD |
| Chronic Kidney Disease | 39.2% of diabetics | Adults 18+ with diabetes |
| Diabetic Retinopathy | 1 in 4 diabetics 40+ | Long-term retinal damage |
| Diabetes-Related Amputations | 154,000 annually | Foot and leg amputations |
| Amputation Disparity (African American) | 4 times higher than whites | Racial health disparity |
| Amputation Disparity (Hispanic) | 50% higher than whites | Ethnic health disparity |
| Death Ranking | 8th leading cause | Among all causes in 2020 |
| Years of Life Lost | 4.6 years earlier death | Adults 50+ with diabetes |
| Years with Disability | 6 to 7 years earlier | Disability onset |
Data Source: CDC National Diabetes Statistics Report 2024, JAMA Ophthalmology 2023, American Diabetes Association 2024, CDC Mortality Data 2024
Diabetes serves as both a direct cause of death and a major contributor to numerous life-threatening complications, ranking as the 8th leading cause of death in the United States in 2020. People with diabetes face 1.5 to 2 times greater risk of developing cardiovascular disease, including heart attack and stroke, which represent the leading causes of death among diabetics. The healthcare system burden manifests through 16.8 million diabetes-related emergency room visits annually among adults and 7.86 million hospital discharges listing diabetes among diagnoses, with 1.68 million of these also involving major cardiovascular disease, including 368,000 with ischemic heart disease and 321,000 with stroke.
Diabetes devastates multiple organ systems over time, with 39.2 percent of adults with diagnosed diabetes also suffering from chronic kidney disease, potentially progressing to kidney failure requiring dialysis or transplantation. Vision loss affects approximately 1 in 4 Americans aged 40 and older with diabetes through diabetic retinopathy, caused by damage to retinal blood vessels. Nerve damage combined with poor circulation leads to 154,000 diabetes-related foot and leg amputations annually, with stark racial and ethnic disparities as African Americans face 4 times higher amputation rates than whites and Hispanic communities experience 50 percent higher rates. Adults aged 50 and older with diabetes die 4.6 years earlier, develop disability 6 to 7 years sooner, and spend about 1 to 2 more years in disabled states compared to those without diabetes, illustrating how this disease robs individuals of both quantity and quality of life.
Diabetes Prevention and Management in the US 2025
| Prevention/Management Strategy | Effectiveness | Key Details |
|---|---|---|
| Weight Loss (5-7%) | 58% risk reduction | With 150 min/week exercise |
| Weight Loss (5-7%) Ages 60+ | 71% risk reduction | For older adults |
| Weight Loss (10%+) | Blood sugar improvement | Potential diabetes remission |
| Physical Activity Recommendation | 150 minutes per week | Moderate/vigorous activity |
| Diabetes Self-Management Education (DSMES) | Improved outcomes | Evidence-based programs |
| National Diabetes Prevention Program | Proven effective | CDC-recognized lifestyle change program |
| Prediabetes Awareness | Only 19.3% | Low awareness among affected |
| Regular Screening Recommendation | Starting age 35 | American Diabetes Association |
| Healthcare Provider Visits | Critical for management | Dental, foot, eye exams |
Data Source: National Diabetes Prevention Program 2021-2024, CDC Diabetes Prevention 2024, American Diabetes Association Guidelines 2024
Diabetes prevention represents one of the most cost-effective interventions in all of medicine, with robust evidence demonstrating that modest lifestyle changes can prevent or substantially delay type 2 diabetes development in high-risk individuals. The National Diabetes Prevention Program has proven that adults with prediabetes who lost just 5 to 7 percent of their body weight (roughly 10-15 pounds for a 200-pound person) and engaged in 150 minutes of moderate physical activity weekly reduced their type 2 diabetes risk by an impressive 58 percent, with even greater 71 percent risk reduction observed in adults aged 60 and older, proving that it’s never too late to benefit from lifestyle modification.
For those who lose more than 10 percent of body weight, benefits extend beyond prevention to actual disease improvement, with many experiencing substantial blood sugar reductions and some achieving diabetes remission where blood glucose returns to normal ranges without medication. The American Diabetes Association recommends that all adults begin diabetes screening at age 35, with younger adults who are overweight or obese and have additional risk factors (hypertension, high cholesterol, family history) screened even earlier. However, only 19.3 percent of people with prediabetes know they have the condition, representing a massive missed opportunity for prevention. For those already diagnosed, Diabetes Self-Management Education and Support (DSMES) programs provide evidence-based training in nutrition, physical activity, medication management, blood glucose monitoring, and complication prevention, substantially improving health outcomes when patients actively participate. Healthcare providers play crucial roles through regular screening, patient education, medication management, and monitoring for complications through annual eye exams, foot exams, kidney function tests, and dental care.
Regional Diabetes Patterns and the Diabetes Belt in the US 2025
| Geographic Region | Diabetes Prevalence Pattern | Defining Characteristics |
|---|---|---|
| Diabetes Belt (Southeast) | 15.8% to 18.2% | Mississippi, West Virginia, Louisiana, Alabama, Arkansas, Tennessee, Kentucky, South Carolina, Georgia, portions of Texas, North Carolina, Ohio, Pennsylvania, Virginia |
| Western States | 7.8% to 10.5% | Colorado, Utah, Montana, Idaho, Alaska, Wyoming |
| Northeastern States | 8.6% to 11.0% | Vermont, New Hampshire, Massachusetts, Connecticut |
| Midwest States | 9.4% to 12.5% | Minnesota, North Dakota, South Dakota, Iowa, Wisconsin |
| Rural Areas Nationally | 14.3% | Nonmetropolitan counties |
| Urban Areas Nationally | 11.2% | Metropolitan counties |
| Southeast Rural Counties | Up to 21.3% | Highest rural prevalence (North Carolina) |
Data Source: CDC Diabetes Atlas 2024, CDC Geographic Analysis 2024, CDC Rural Health Study 2021
The United States exhibits pronounced geographic clustering of diabetes prevalence, with the southeastern region forming what epidemiologists have termed the “Diabetes Belt”—a contiguous area where diabetes rates consistently exceed national averages by substantial margins. This belt encompasses Mississippi, West Virginia, Louisiana, Alabama, Arkansas, Tennessee, Kentucky, South Carolina, Georgia, and portions of Texas, North Carolina, Ohio, Pennsylvania, and Virginia, where prevalence ranges from 15.8 percent to 18.2 percent. This geographic concentration reflects complex interactions of poverty, limited healthcare access, cultural dietary patterns emphasizing fried foods and sweet beverages, higher obesity rates, lower educational attainment, and food insecurity.
Conversely, Western states including Colorado, Utah, Montana, Idaho, Alaska, and Wyoming demonstrate substantially lower diabetes prevalence ranging from 7.8 percent to 10.5 percent, benefiting from populations that engage in higher levels of outdoor physical activity, have better access to healthcare, show lower obesity rates, and maintain higher educational and income levels. Northeastern states such as Vermont, New Hampshire, Massachusetts, and Connecticut show moderate-low prevalence from 8.6 percent to 11.0 percent, while Midwest states including Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin fall in the 9.4 percent to 12.5 percent range. The rural-urban divide cuts across all regions, with rural areas nationwide experiencing 14.3 percent prevalence versus 11.2 percent in urban areas, and in some southeastern rural counties like North Carolina, diabetes rates climb as high as 21.3 percent—affecting more than 1 in 5 adults—representing the nation’s most severe diabetes burden concentrations and demanding urgent public health interventions.
Complete State-by-State Diabetes Rankings in the US 2025
| National Rank | State | Prevalence (%) | Rank | State | Prevalence (%) |
|---|---|---|---|---|---|
| 1 | West Virginia | 18.2% | 26 | Hawaii | 10.7% |
| 2 | Mississippi | 17.0% | 27 | Oregon | 10.5% |
| 3 | Louisiana | 16.1% | 28 | Wyoming | 10.5% |
| 4 | Alabama | 15.7% | 29 | Minnesota | 10.4% |
| 5 | South Carolina | 14.9% | 30 | New York | 10.4% |
| 6 | Arkansas | 14.5% | 31 | Wisconsin | 10.4% |
| 7 | Tennessee | 14.5% | 32 | Iowa | 10.2% |
| 8 | Delaware | 13.3% | 33 | South Dakota | 10.1% |
| 9 | Indiana | 13.2% | 34 | New Mexico | 10.0% |
| 10 | Ohio | 13.2% | 35 | California | 9.9% |
| 11 | Georgia | 12.7% | 36 | Connecticut | 9.9% |
| 12 | Texas | 12.7% | 37 | Idaho | 9.8% |
| 13 | Kentucky | 12.6% | 38 | Massachusetts | 9.8% |
| 14 | North Carolina | 12.6% | 39 | New Hampshire | 9.8% |
| 15 | Michigan | 12.5% | 40 | Washington | 9.6% |
| 16 | Missouri | 12.5% | 41 | North Dakota | 9.5% |
| 17 | Oklahoma | 12.5% | 42 | Montana | 9.4% |
| 18 | Kansas | 12.2% | 43 | Vermont | 9.3% |
| 19 | Nevada | 12.0% | 44 | Alaska | 8.7% |
| 20 | Arizona | 11.7% | 45 | Colorado | 8.6% |
| 21 | Florida | 11.6% | 46 | Utah | 7.8% |
| 22 | Pennsylvania | 11.5% | 47 | District of Columbia | 7.4% |
| 23 | Illinois | 11.2% | — | Tennessee (Missing) | Data unavailable |
| 24 | Nebraska | 11.1% | — | Rhode Island | Estimate 10-11% |
| 25 | New Jersey | 11.1% | — | Maine | Estimate 10-11% |
Data Source: CDC BRFSS 2024, Statista 2024, KFF State Health Facts 2024, American Diabetes Association 2024
This comprehensive state-by-state ranking reveals the full spectrum of diabetes prevalence across America, from West Virginia’s troubling 18.2 percent (highest) to the District of Columbia’s encouraging 7.4 percent (lowest)—a 2.5-fold difference that translates to vastly different healthcare demands, economic burdens, and population health outcomes. The data demonstrates clear geographic clustering, with 12 of the top 15 highest-prevalence states located in the Southeast, while 8 of the 10 lowest-prevalence states sit in the West or Northeast. Mid-range states including Kansas, Nevada, Arizona, Florida, Pennsylvania, Illinois, Nebraska, and New Jersey fall in the 11.0 percent to 12.2 percent range, representing close to the national average.
Notably, Tennessee data was unavailable for 2024 from the CDC BRFSS survey, though previous years showed the state among the highest-prevalence states at approximately 14.5 percent. Rhode Island and Maine lack specific 2024 data points but historical patterns place both in the 10 percent to 11 percent range. The ranking illustrates how diabetes is not randomly distributed but follows predictable patterns tied to socioeconomic factors, obesity rates, healthcare access, cultural dietary habits, physical activity levels, and state-level policies on health promotion and chronic disease prevention, providing policymakers with a roadmap for where interventions are most urgently needed and where successful strategies might be replicated.
Diabetes Risk Factors and Warning Signs in the US 2025
| Risk Factor Category | Specific Risk Factors | Relative Risk Increase |
|---|---|---|
| Family History | Parent or sibling with diabetes | Substantially elevated risk |
| Age | 45 years or older | Risk increases with age |
| Race/Ethnicity | African American, Hispanic/Latino, American Indian, Pacific Islander, Asian American | Higher risk than whites |
| Weight | Overweight (BMI 25+) | Substantially elevated |
| Weight | Obesity (BMI 30+) | 4 times higher risk |
| Physical Activity | Physical inactivity | Significantly elevated |
| Blood Pressure | Hypertension (140/90 or higher) | Associated elevated risk |
| Cholesterol | HDL below 35 or triglycerides above 250 | Metabolic syndrome indicators |
| Gestational Diabetes | History during pregnancy | 50% develop Type 2 within 10 years |
| Polycystic Ovary Syndrome (PCOS) | Women with PCOS | Substantially elevated |
| Previous High Blood Sugar | History of prediabetes or impaired glucose tolerance | High progression risk |
Data Source: American Diabetes Association Risk Assessment 2024, CDC Diabetes Prevention 2024, National Diabetes Education Program 2024
Multiple risk factors combine to determine an individual’s likelihood of developing diabetes, with some factors modifiable through lifestyle changes while others remain fixed. Family history represents one of the strongest risk factors, as having a parent or sibling with diabetes substantially increases one’s own risk through both genetic predisposition and shared environmental factors. Age 45 or older marks when diabetes risk begins climbing substantially, though Type 2 diabetes increasingly affects younger individuals. Race and ethnicity profoundly influence risk, with African Americans, Hispanic/Latino individuals, American Indians, Pacific Islanders, and Asian Americans all experiencing higher diabetes rates than non-Hispanic whites due to genetic susceptibility combined with social determinants of health.
Excess body weight stands as the most important modifiable risk factor, with overweight individuals (BMI 25 or higher) showing substantially elevated risk and obese individuals (BMI 30 or higher) facing approximately 4 times greater risk than normal-weight persons. Physical inactivity independently increases diabetes risk regardless of weight status, while hypertension (blood pressure 140/90 mmHg or higher) and abnormal cholesterol levels (HDL below 35 mg/dL or triglycerides above 250 mg/dL) indicate metabolic dysfunction that often precedes diabetes. Women with history of gestational diabetes face 50 percent risk of developing Type 2 diabetes within 5 to 10 years, those with polycystic ovary syndrome (PCOS) show significantly elevated risk, and individuals with previous high blood sugar readings, prediabetes, or impaired glucose tolerance sit at immediate high risk for progression to diabetes, making them priority targets for prevention interventions focusing on weight loss, physical activity, and healthy eating patterns.
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