Diabetes Prevention and Control:
A Public Health Imperative

The Burden of Diabetes Among Americans Continues to Grow

Type 2 diabetes, which affects 17 million Americans and their families,¹ often causes severe complications that can ultimately damage every organ in the body and lead to premature death. These complications include heart disease, blindness, lower extremity arterial disease, kidney failure, dental disease, and increased susceptibility to infections. In many states, half of all people with diabetes do not receive recommended preventive care services that are known to reduce the risk of diabetes complications.² The direct economic cost of diabetes in the United States is estimated to be nearly $132 billion per year.³ This figure does not take into account the indirect economic costs attributable to potential work time lost to diabetes-related illness or premature death.

The prevalence of diagnosed type 2 diabetes increased sixfold in the latter half of the last century.⁴ Diabetes risk factors such as obesity and physical inactivity have played a major role in the dramatic increase in rates of type 2 diabetes in recent years. Age, race, and ethnicity are also important risk factors. The prevalence of diabetes increases with age in all racial and ethnic groups. Whereas 8.6% of Americans over age 20 have diabetes, 20.1% of Americans over age 65 have diabetes. Far fewer Americans younger than age 20 have diabetes, but the prevalence of diabetes in this age group appears to be rising considerably. The rising prevalence of diabetes in this age group, as in other age groups, is attributed to increases in physical inactivity and obesity.

American Indians, black Americans, Latino Americans, and some Asian Americans and Pacific Islanders are disproportionately affected by diabetes.¹ For example, black and Hispanic Americans are almost twice as likely to have diabetes as non-Hispanic white Americans of similar age, and American Indians are almost three times as likely to have diabetes as non-Hispanic whites of similar age. As the prevalence of obesity and sedentary lifestyles increases and the U.S. population becomes older and more ethnically diverse, the prevalence of diabetes is expected to continue to rise.⁵

Socioeconomic and environmental factors may also play a role in a person’s risk of developing diabetes and in the course of diabetes once it has developed.⁵ People with type 2 diabetes are more likely to have less education and lower incomes than people without diabetes.⁶ Elderly minority women, who are more likely to live alone and to have lower socioeconomic status, are also more likely to have diabetes and to lack resources to adequately manage their disease.⁷

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