American Diabetes Association Data Reveals Gender Variations; Three-Fold Difference in #Diabetes Prevalence Across the U.S

American Diabetes Association Data Reveals Gender Variations; Three-Fold Difference in #Diabetes Prevalence Across the U.S


Data Includes Diagnosed, Undiagnosed and Total Diabetes Prevalence, as well as Rates of Successful Treatment and Awareness

A county-level analysis of diabetes data, published in Diabetes Care on August 23, 2016, reveals wide variations in prevalence across the United States, with a three-fold difference in prevalence among counties with the highest and lowest rates. The analysis also finds stark differences among rates of diagnosis, diabetes awareness and effective treatment, which could help policymakers and healthcare providers identify areas in need of greater public health resources.

“These results, detailing county-by-county trends, can play an important role in providing health care leaders and policymakers with a blueprint for communities demonstrating the greatest need for more effective diabetes prevention and treatment strategies,” said Laura Dwyer-Lindgren, the paper’s lead author and a researcher with the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “We hope our findings will be used to target high-burden areas and to help select the right mix of public health strategies for each community. This data empowers leaders at the local and national level to make dramatic improvements in public health.”

The analysis showed that total diabetes prevalence (including diagnosed and undiagnosed) ranged from 8.8 percent (Los Alamos County, NM) to 26.4 percent (Starr County, TX) of the population among American counties in 2012. Overall, counties in the deep South (excluding Florida), those close to the Mexican border in Texas, and counties with Native American reservations in the Four Corners region of the Southwest and in North and South Dakota, exhibited the highest prevalence. Prevalence was lowest in counties in the upper West and Midwest, parts of Alaska and parts of New England. Colorado, interestingly, was home to seven of the top 10 counties with the lowest prevalence.


Total Diabetes Prevalence          
FIPS State County Rank       Age-standardized prevalence, both sexes combined
Mean Lower bound Upper bound
Top 10 Counties (with lowest prevalence)        
35028 New Mexico Los Alamos County 1 8.8 7.4 10.2
8035 Colorado Douglas County 2 8.9 7.7 10.0
8053 Colorado Hinsdale County 3 8.9 7.7 10.0
8097 Colorado Pitkin County 4 8.9 7.7 10.0
8091 Colorado Ouray County 5 8.9 7.6 10.2
8107 Colorado Routt County 6 9.1 8.0 10.2
49043 Utah Summit County 7 9.2 8.2 10.2
56039 Wyoming Teton County 8 9.2 8.1 10.4
8117 Colorado Summit County 9 9.3 8.0 10.5
8079 Colorado Mineral County 10 9.4 7.9 10.8
Top 10 Counties (with highest prevalence)        
1063 Alabama Greene County 3,133 23.7 20.7 26.7
48047 Texas Brooks County 3,134 23.8 20.6 27.0
48507 Texas Zavala County 3,135 23.8 20.5 27.1
13259 Georgia Stewart County 3,136 23.8 20.9 26.7
28063 Mississippi Jefferson County 3,137 23.9 21.1 26.6
48479 Texas Webb County 3,138 24.3 21.2 27.3
1119 Alabama Sumter County 3,139 24.3 21.7 27.0
28051 Mississippi Holmes County 3,140 24.8 22.0 27.6
46102 South Dakota Oglala Lakota County 3,141 25.1 21.3 28.9
48427 Texas Starr County 3,142 26.4 22.5 30.3



The researchers analyzed 1999-2012 data from the National Health and Nutrition Examination Survey (NHANES), which combines interviews and physical exams held annually in 15 counties to determine the health and nutritional status of children and adults from, and the Behavioral Risk Factor Surveillance System (BRFSS), which uses telephone surveys conducted in every state to collect data about U.S. residents’ health-related risk behaviors, chronic health conditions and use of preventive services.

Combining these data created a more complete picture of the burden of diabetes in each county and also allowed researchers to look at markers of how well the health system is responding to this burden, namely, rates of diagnosis and rates of successful treatment.


Key Findings


The analysis showed diagnosed diabetes prevalence for the nation as a whole was 10.2 percent in 2012, and undiagnosed diabetes prevalence was 4.1 percent, with a total diabetes prevalence of 14.3 percent of the population. At the county level, diagnosed diabetes prevalence ranged from 5.6 percent to 20.4 percent, whereas undiagnosed diabetes prevalence ranged from 3.2 percent to 6.8 percent.


Nationally, total diabetes prevalence rose by 40 percent from 1999 to 2012, from 10.2 percent to 14.3 percent of the population. Though prevalence increased among all counties, the rate of increase varied widely, from 18.9 percent to 72 percent. The increase in diagnosed diabetes showed an even wider variation among counties, from 25.2 percent to 117.1 percent. Nationally, the increase in prevalence was larger for diagnosed diabetes (56.8 percent) than for undiagnosed diabetes (10.3 percent).



Diabetes prevalence was higher among men than women both at the national level and in 95.1 percent of the counties analyzed. Diagnosed diabetes was only slightly higher among men than among women (10.6 percent vs. 9.9 percent), but undiagnosed diabetes was substantially higher (5.0 percent among men vs. 3.2 percent among women). Total diabetes prevalence was 15.6 percent among men vs. 13.0 percent among women.


Diabetes Awareness

Diabetes awareness also varied widely among counties, ranging from 59.1 percent to 79.8 percent of the population. Awareness was defined as the proportion of adults age 20 or older with a previous diabetes diagnosis and/or high FPG or A1C with a diagnosis (the ratio of diagnosed to total diabetes prevalence). Awareness increased 12 percent from 1999 to 2012, from 63.9 percent to 71.6 percent. During that same period, diabetes control rose only slightly, by 1.5 percent.



“The variation in total diabetes prevalence within the U.S. is staggering, with a threefold difference between the counties with the lowest prevalence and those with the highest prevalence,” the researchers concluded. “Given the significant health and financial burden of high diabetes prevalence, this disparity demands further investigation into what underlying (and potentially modifiable) factors drive the exceedingly high diagnosed and total diabetes rates found in many communities.”


“Diabetes is both preventable and treatable,” they continued in the study’s conclusion. “The public health system has a role to play in increasing awareness of and screening for diabetes, connecting affected and high-risk individuals with appropriate medical care, and promoting community level interventions that address known risk factors such as poor diet or lack of physical activity. The results of this analysis should be considered by state and local health officials aiming to increase early detection and improve the health of impacted communities.”



SOURCE: American Diabetes Association,

ARTICLE: Copies of the full article are available online at

MAP: Map of diabetes prevalence by county available upon request.

About the American Diabetes Association
The American Diabetes Association is leading the fight to Stop Diabetes® and its deadly consequences and is fighting for those affected by diabetes. The Association funds research to prevent, cure, and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, the Association’s mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit


MEDIA CONTACT: Michelle Kirkwood, 703-299-2053


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