Diabetes Report Card 2021
The Diabetes Report Card provides current information on the status of diabetes and its complications in the United States. It has been published every 2 years since 2012 by the Centers for Disease Control and Prevention (CDC).
This publication includes information and data on diabetes, preventive care practices, health outcomes, and risk factors such as race, ethnicity, level of education, and prediabetes. It includes information about national trends and, where possible, state-level data. It also provides information about the relationship between diabetes and COVID-19.
Public health professionals, policy makers, state health departments, and communities can use these data to focus their type 2 diabetes prevention and diabetes management efforts on areas of greatest need.
- After almost 2 decades of continual increases, the incidence of newly diagnosed cases of diabetes in the United States decreased from 9.3 per 1,000 adults in 2009 to 5.9 per 1,000 adults in 2019.10
- Prevalence of prediabetes among US adults remained steady from 2005–2008 to 2017–2020. However, notification of prediabetes status nearly tripled (from 6.5% to 17.4%).10
- American Indian or Alaska Native, non-Hispanic Black, Hispanic, and non-Hispanic Asian people are more likely to be diagnosed with diabetes than non-Hispanic White people (14.5%, 12.1%, 11.8%, 9.5%, and 7.4%, respectively).10
- During the COVID-19 pandemic, diabetes emerged as an underlying condition that increases the chance of severe illness. Nearly 4 in 10 adults who died from COVID-19 in the United States also had diabetes.11
Diabetes is a group of diseases characterized by high blood sugar. When a person has diabetes, the body either does not make enough insulin (type 1) or is unable to properly use insulin (type 2). When the body does not have enough insulin or cannot use it properly, blood sugar (glucose) builds up in the blood. Prediabetes is a condition in which blood sugar is higher than normal but not high enough to be classified as diabetes.
People with diabetes can develop high blood pressure, high cholesterol, and high triglycerides (a type of fat in the blood). High blood sugar, particularly when combined with high blood pressure and high triglycerides or too much LDL (“bad”) cholesterol levels, can lead to heart disease, stroke, blindness, kidney failure, amputations of the legs and feet, and even early death.1
Diabetes is also associated with increased risk of certain types of cancer, such as liver, pancreas, uterine, colon, breast, and bladder cancer.2 High blood sugar also increases the chance of developing dementia and Alzheimer’s disease.3 In addition, the average medical costs for people with diagnosed diabetes are 2.3 times higher than costs for people without diabetes.4 These higher costs are often caused by diabetes-related health conditions and resulting hospitalizations.
People with diabetes, their caregivers and health care providers, departments of health, policy makers, and community organizations can help to reduce the risk of serious diabetes-related complications. For people with diabetes, research shows that:
- Blood pressure management can reduce the risk of heart disease and stroke by 12% to 27% and the risk of progression of kidney disease by 30% to 70%.5,6
- Cholesterol management can reduce cardiovascular complications by 20% to 50%.7
- Regular eye exams and timely treatment could prevent up to 90% of diabetes-related blindness.8
- Regular foot exams and patient education could prevent up to 85% of diabetes-related amputations.9
The estimates in this report were calculated by staff from CDC’s Division of Diabetes Translation and are available in more detail in CDC’s National Diabetes Statistics Report and from the USDSS. Diabetes data are from the US Census Bureau, the Indian Health Service’s National Data Warehouse, the SEARCH for Diabetes in Youth Study, and various surveys and data collection systems. These systems include the BRFSS, the National Health Interview Survey, the National Health and Nutrition Examination Survey, the National Hospital Discharge Survey, and the National Vital Statistics System.
To make meaningful comparisons between states and over time, we used the US Census Bureau’s 2000 US standard population to age-adjust our estimated rates. Age adjustment is a statistical process applied to rates of diseases, injuries, and health outcomes. It allows comparisons between communities with different age structures because it proportions rates to a standard age structure. Three-year moving averages are sometimes used to improve the precision of estimates. State estimates in this report card are based on BRFSS data. Because of the limitations of self-reported data in surveys, these estimates may underreport the rates of diabetes, prediabetes, and notification of prediabetes by a health professional in the US population.
Updated data on diabetes and prediabetes in youth is unavailable.
- Centers for Disease Control and Prevention. Diabetes Basics: What is Diabetes? Accessed November 9, 2021. https://www.cdc.gov/diabetes/basics/diabetes.html
- Okhuma T, Peters SAE, Woodward M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million eventsexternal icon. Diabetologia. 2018;61:2140–2154.
- Dolan C, Glynn R, Griffin S, et al. Brain complications of diabetes mellitus: a cross-sectional study of awareness among individuals with diabetes and the general population in Irelandexternal icon. Diabet Med. 2018;35(7):871–879.
- American Diabetes Association. Economic costs of diabetes in the U.S. in 2017external icon. Diabetes Care. 2018;41:917–928.
- Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysisexternal icon. JAMA. 2015;313(6):603–615.
- Lewis EJ, Hunsicker LG, Clarke WR, et al.; Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetesexternal icon. N Engl J Med. 2001;345:851–860.
- Daniel MJ. Lipid management in patients with type 2 diabetesexternal icon. Am Health Drug Benefits. 2011;4:312–322.
- Murchison AP, Hark L, Pizzi LT, et al. Non-adherence to eye care in people with diabetesexternal icon. BMJ Open Diabetes Res Care. 2017;5(1):e000333.
- Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult US populationexternal icon. Diabetes Care. 2019;42(1):50–54.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report. Accessed February 5, 2022. https://www.cdc.gov/diabetes/data/statistics-report/index.html
- Gold JA, Wong KK, Szablewski CM, et al. Characteristics and clinical outcomes of adult patients hospitalized with COVID-19 — Georgia, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(18):545–550.
- Ahmad FB, Cisewski JA, Minino A, Anderson RN. Provisional mortality data — United States, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(14):519–522.
- Bardenheier BH, Lin J, Zhuo X, et al. Disability-free life-years lost among adults aged ≥50 years with and without diabetesexternal icon. Diabetes Care. 2016;39(7):1222–1229.
- Centers for Disease Control and Prevention. What is Type 1 Diabetes? Accessed April 4, 2022. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html
- Center for Disease Control and Prevention. Diabetes Risk Factors. Accessed March 18, 2022. https://www.cdc.gov/diabetes/basics/risk-factors.html
- Bullock A, Sheff K, Hora I, et al. Prevalence of diagnosed diabetes in American Indian and Alaska Native adults, 2006-2017external icon. BMJ Open Diab Res Care. 2020;8(1):e001218.
- Cho P, Geiss LS, Burrows NR, Roberts DL, Bullock AK, Toedt ME. Diabetes-related mortality among American Indians and Alaska Natives, 1990-2009external icon. Am J Public Health. 2014;104:S496–S503.
- Burrows NR, Zhang Y, Hora I, et al. Sustained lower incidence of diabetes-related end-stage kidney disease among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000-2016external icon. Diabetes Care. 2020;43(9):2090–2097.
- Beckles GL, Chou C. Disparities in the prevalence of diagnosed diabetes — United States, 1999–2002 and 2011–2014. MMWR Morb Mortal Wkly Rep. 2016;65(45):1265–1269.
- Luo H, Beckles GL, Zhang X, Sotnikov S, Thompson T. The relationship between county-level contextual characteristics and use of diabetes care services.external icon J Public Health Manag Pract. 2014;20(4):401–410.
- Centers for Disease Control and Prevention. US Diabetes Surveillance System. Accessed November 5, 2021. https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
- Rutledge SA, Masalovich S, Blacher RJ, Saunders MM. Diabetes self-management education programs in nonmetropolitan counties — United States, 2016. MMWR Surveill Summ. 2017;66(suppl 10):1–6.
- Carr D, Kappagoda M, Boseman L, Cloud LK, Croom B. Advancing diabetes-related equity through diabetes self-management education and training: existing coverage requirements and considerations for increased participationexternal icon. J Public Health Manag Pract, 2020;26(suppl 2):S37–S44.
- Introduction: Standards of medical care in diabetes—2020external icon. Diabetes Care. 2020;43(1):S1–S2.
- Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.external icon J Acad Nutr Diet. 2015;115(8):1323–1334.
- Mendez I, Lundeen EA, Saunders M, Williams A, Saaddine J, Albright A. Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practicesexternal icon. The Science of Diabetes Self-Management and Care. 2022;48(1):23-34.
- Burd C, Gruss S, Albright A, Zina A, Schumacher P, Alley D. Translating knowledge into action to prevent type 2 diabetes: Medicare expansion of the National Diabetes Prevention Program lifestyle interventionexternal icon. Milbank Q. 2020;98(1):172–196.
- Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metforminexternal icon. N Engl J Med. 2002;346(6):393–403.
- National Association of Chronic Disease Directors. National Diabetes Prevention Program Coverage Toolkit. Accessed November 5, 2021. https://coveragetoolkit.org/external icon
- Center for Disease Control and Prevention. People With Certain Medical Conditions. Accessed March 18, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
- Centers for Disease Control and Prevention. Science Brief: Evidence Used to Update the List of Underlying Medical Conditions Associated With Higher Risk for Severe COVID-19. Accessed March 18, 2022. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/underlying-evidence-table.html
- Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(24):759–765.
- Lavery AM, Preston LE, Ko JY, et al. Characteristics of hospitalized COVID-19 patients discharged and experiencing same-hospital readmission — United States, March–August 2020. MMWR Morb Mortal Wkly Rep. 2020;69(45);1695–1699.
- Barrett CE, Koyama AK, Alvarez P, et al. Risk for newly diagnosed diabetes >30 days after SARS-CoV-2 infection among persons aged <18 years — United States, March 1, 2020–June 28, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(2):59–65.
- Vadheim LM, Patch K, Brokaw SM, et al. Telehealth delivery of the diabetes prevention program to rural communitiesexternal icon. Transl Behav Med. 2017;7(2):286–291.
- Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 pandemic on emergency department visits — United States, January 1, 2019–May 30, 2020external icon. MMWR Morb Mortal Wkly Rep. 2020;69(23):699–704.
- Lange SJ, Ritchey MD, Goodman AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions — United States, January–May 2020external icon. MMWR Morb Mortal Wkly Rep. 2020;69(25):795–800.
- Czeislar ME, Barrett CE, Siegel KR, et al. Health care access and utilization among adults with diabetes during the COVID-19 pandemic — United States, February to March 2021. MMWR Morb Mortal Wkly Rep. 70(46):1597–1602.
- Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics associated with hospitalization among patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020external icon. MMWR Morb Mortal Wkly Rep. 2020;69(25):790–794.
- Centers for Disease Control and Prevention. COVID-NET. Laboratory-Confirmed COVID-19-Associated Hospitalizations. Accessed March 18, 2022. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html
- Centers for Disease Control and Prevention. Data Modernization Initiative Strategic Implementation Plan. Accessed April 1, 2022. https://www.cdc.gov/surveillance/pdfs/FINAL-DMI-Implementation-Strategic-Plan-12-22-21.pdfpdf icon
- Centers for Disease Control and Prevention. Diabetes State Burden Toolkit. Accessed November 5, 2021. https://nccd.cdc.gov/Toolkit/DiabetesBurden
- Centers for Disease Control and Prevention. Diabetes Prevention Impact Toolkit. Accessed November 5, 2021. https://nccd.cdc.gov/Toolkit/DiabetesImpact
- Centers for Disease Control and Prevention. Diabetes Self-Management Education and Support Toolkit. Accessed November 5, 2021. https://www.cdc.gov/diabetes/dsmes-toolkit
- Centers for Disease Control and Prevention. National Diabetes Prevention Program. Find a Program. Accessed December 17, 2021. https://www.cdc.gov/diabetes/prevention/find-a-program.html
- Centers for Disease Control and Prevention. National Diabetes Prevention Program Customer Service Center. Accessed November 5, 2021. https://nationaldppcsc.cdc.gov/s/
- Centers for Disease Control and Prevention. CDC-Recognized Lifestyle Change Program. How Pharmacists Can Participate. Accessed November 5, 2021. https://www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/pharmacists.html
- Centers for Disease Control and Prevention. Chronic Kidney Disease (CKD) Surveillance System. Accessed November 5, 2021. https://nccd.cdc.gov/CKD/default.aspx
- Centers for Disease Control and Prevention. Vision Health Initiative. State Profiles. Accessed November 5, 2021. https://www.cdc.gov/visionhealth/data/state-profiles/index.htm
Purpose of This Report
This report is required under the Catalyst to Better Diabetes Care Act of 2009 (Section 10407 of Public Law 111-148). This act calls for a diabetes report card that includes information and data about diabetes, prediabetes, preventive care practices, risk factors, quality of care, diabetes outcomes, and, to the extent possible, trend and state data.
Centers for Disease Control and Prevention. Diabetes Report Card 2021. US Dept of Health and Human Services; 2022.
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