Diabetes affects roughly 40.1 million people in the United States, and the burden falls unevenly. Black, Hispanic, American Indian, and Alaska Native adults have significantly higher rates than white adults. Lower income, less education, rural geography, and older age all independently increase risk. About 11 million of those 40.1 million people don’t even know they have diabetes yet.
Race and Ethnicity
The disparities by race are stark. Among U.S. adults, Black non-Hispanic individuals have the highest total diabetes prevalence at 20.7%, based on 2021–2023 CDC data. Hispanic adults follow at 17.1%, and Asian non-Hispanic adults at 14.5%. American Indian and Alaska Native adults have a diagnosed diabetes rate of 15.7%, though the true total (including undiagnosed cases) is likely higher. For comparison, white non-Hispanic adults have the lowest rates among major demographic groups.
These gaps aren’t just about who gets diabetes. They also shape who suffers the worst complications. Native Americans have one of the highest rates of diabetic eye disease, with retinopathy affecting about 45% of those with diabetes, compared to roughly 18% of white adults. Black adults develop kidney failure from diabetes at more than four times the rate of white adults. Hispanic Americans also face elevated risks of both kidney disease and vision loss. These complications often reflect differences in access to consistent, quality care rather than biology alone.
Income and Education Level
Poverty is one of the strongest predictors of diabetes. Adults with family incomes below the federal poverty level have a diabetes prevalence of 13.1%, more than double the 5.1% rate among those earning five times the poverty level or more. The reasons compound: lower-income neighborhoods tend to have fewer grocery stores with fresh produce, fewer safe spaces for physical activity, and less access to preventive healthcare.
Education tells a similar story. Adults without a high school diploma are about twice as likely to have diabetes as college graduates, a gap that has persisted for two decades. What’s changed is the middle: between 2001 and 2020, diabetes prevalence among adults with only a high school diploma surged by 10.6 percentage points, the fastest increase of any education group. Adults with some college saw a 6-point increase over the same period. The disparity between a high school diploma and a college degree, once modest, has widened dramatically.
Where You Live Matters
Diabetes prevalence runs 9% to 17% higher in rural areas than in urban ones. Across 41 states analyzed in 2021, the rural diabetes rate averaged 14.3% compared to 11.2% in urban areas. The gap varies widely by state. In North Carolina, rural diabetes prevalence hit 21.3%, the highest of any state studied, while urban areas in the same state were notably lower. Colorado had the lowest rates in both categories, at 8.4% rural and 6.9% urban.
Part of this rural-urban divide is explained by demographics: rural populations tend to be older, have lower incomes, and have higher obesity rates. But in several states, including North Carolina and Oregon, the gap persists even after accounting for age, sex, race, income, education, and obesity. Something about rural living itself, whether it’s distance from specialists, limited health infrastructure, or cultural factors, contributes independently to higher diabetes rates.
Age and the Rise in Youth Diabetes
Diabetes risk increases with age, and the majority of people living with type 2 diabetes are over 45. But one of the most concerning trends is how quickly diabetes is growing among young people under 20. CDC researchers who studied data from 2002 to 2017 projected that if diagnosis rates keep rising at the same pace, type 2 diabetes cases in youth could increase by roughly 700% by 2060. Even if rates hold steady and don’t accelerate, cases would still climb about 70% due to population growth alone.
Type 1 diabetes, which is autoimmune and not related to lifestyle, is also projected to rise, potentially increasing 65% among youth if current trends continue. But the explosion in type 2 diabetes among children and teenagers is what alarms public health experts, because type 2 was once considered an adult disease almost exclusively. The steepest increases are projected among Black, Hispanic, Asian, Pacific Islander, and American Indian or Alaska Native youth, meaning racial disparities that already exist in adults are being replicated, and potentially amplified, in the next generation.
Type 1 vs. Type 2: Different Patterns
Type 1 and type 2 diabetes affect different populations in different ways. Type 1 is most commonly diagnosed in childhood and young adulthood, occurs across all racial and income groups, and cannot be prevented through lifestyle changes. It accounts for a smaller share of total diabetes cases but requires lifelong insulin use from the point of diagnosis.
Type 2 accounts for the vast majority of diabetes cases and is the type driving nearly all of the disparities described above. It clusters in communities with higher rates of obesity, food insecurity, and limited healthcare access. Among youth specifically, type 2 diabetes prevalence is highest in Black non-Hispanic children, and the racial gap is expected to widen substantially through 2060. The overlap between the groups most affected by poverty, structural disadvantage, and type 2 diabetes is not coincidental. These factors reinforce each other across generations.
Why These Disparities Persist
The groups most affected by diabetes share overlapping risk factors that go beyond individual behavior. Lower income limits access to healthier food and regular medical care. Living in a rural area can mean driving an hour to see an endocrinologist. Historical inequities in housing, employment, and healthcare access have created environments where diabetes thrives in certain communities more than others.
Undiagnosed diabetes illustrates the problem clearly. About 27.6% of U.S. adults with diabetes don’t know they have it, representing 11 million people. Undiagnosed diabetes is more common in groups with less healthcare access, meaning the populations already at highest risk are also the least likely to catch the disease early, when management is most effective and complications are still preventable.