National Diabetes Statistics Report

Information about the methods used in this report is available here and appendix with detailed tables and data sources.

Prevalence of both diagnosed and undiagnosed diabetes

Among the U.S. population overall, crude estimates for 2021 were:

• 38.4 million people of all ages—or 11.6% of the U.S. population—had diabetes.
• 38.1 million adults aged 18 years or older—or 14.7% of all U.S. adults—had diabetes (Table 1a; Table 1b).
• 8.7 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes, Table 1b). This number represents 3.4% of all U.S. adults (Table 1a) and 22.8% of all U.S. adults with diabetes.
• The percentage of adults with diabetes increased with age, reaching 29.2% among those aged 65 years or older (Table 1a).

Table 1a. Estimated crude prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 2017–2020

Notes: CI = confidence interval. Time period 2017–2020 covers January 2017 through March 2020 only. Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding. Age-adjusted estimates are presented in Appendix Table 1. Data source: 2017–March 2020 National Health and Nutrition Examination Survey.

Table 1b. Estimated number of adults aged 18 years or older with diagnosed diabetes, undiagnosed diabetes, and total diabetes, United States, 2021

Notes: CI = confidence interval. Estimated numbers for 2021 were derived from percentages for 2017–March 2020 applied to July 1, 2021, U.S. resident population estimates from the U.S. Census Bureau (See detailed methods and data sources). Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding.

Data sources: 2017–March 2020 National Health and Nutrition Examination Survey; 2021 U.S. Census Bureau data.

Trends in prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes

• During 2001–2020, the age-adjusted prevalence of total diabetes significantly increased among adults aged 18 years or older (Figure 1).
• Prevalence estimates for total diabetes were 10.3% in 2001–2004 and 13.2% in 2017–2020 (Appendix Table 2).
• During this period, the age-adjusted prevalence significantly increased for diagnosed diabetes. No significant change in undiagnosed diabetes prevalence was found (Figure 1; Appendix Table 2).

Figure 1. Trends in age-adjusted prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 2001–2020

Notes: Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Time period 2017–2020 covers January 2017 through March 2020 only.

Prevalence of diagnosed diabetes

Among the U.S. population overall, crude estimates for 2021 were:

• 29.7 million people of all ages—or 8.9% of the U.S. population—had diagnosed diabetes.
• 352,000 children and adolescents younger than age 20 years—or 35 per 10,000 U.S. youths—had diagnosed diabetes. This includes 304,000 with type 1 diabetes.
• 1.7 million adults aged 20 years or older—or 5.7% of all U.S. adults with diagnosed diabetes—reported both having type 1 diabetes and using insulin.
• 3.6 million adults aged 20 years or older—or 12.3% of all U.S. adults with diagnosed diabetes—started using insulin within a year of their diagnosis.

Among U.S. adults aged 18 years or older, age-adjusted data for 2019–2021 indicated the following:

• For both men and women, prevalence of diagnosed diabetes was highest among American Indian and Alaska Native adults (13.6%), followed by non-Hispanic Black adults (12.1%), adults of Hispanic origin (11.7%), non-Hispanic Asian adults (9.1%) and non-Hispanic White adults (6.9%) (Appendix Table 3).
• Prevalence varied significantly by education level, which is an indicator of socioeconomic status. Specifically, 13.1% of adults with less than a high school education had diagnosed diabetes versus 9.1% of those with a high school education and 6.9% of those with more than a high school education (Appendix Table 3).
• Adults with family income above 500% of the federal poverty level had the lowest prevalence for both men (6.3%) and women (3.9%) (Appendix Table 3).
• For both men and women, prevalence was higher among adults living in nonmetropolitan areas compared to those in metropolitan areas (Figure 2; Appendix Table 3).

Figure 2. Age-adjusted estimated prevalence of diagnosed diabetes by metropolitan residence and sex for adults aged 18 years or older, United States, 2019–2021

Note: Error bars represent upper and lower bounds of the 95% confidence interval.

Table 2. Crude prevalence of diagnosed diabetes by detailed race and ethnicity among adults aged 18 years or older, United States, 2019–2021

Note: CI = confidence interval. Data sources: National Center for Health Statistics; 2019–2021 National Health Interview Survey.

County-level prevalence among adults

Among U.S. adults aged 20 years or older, age-adjusted, county-level data indicated:

• In 2021, estimates of diagnosed diabetes prevalence varied across U.S. counties, ranging from 4.4% to 17.9% (Figure 3).
• Median county-level prevalence of diagnosed diabetes increased from 6.3% in 2004 to 8.3% in 2021.

Figure 3. Age-adjusted, county-level prevalence of diagnosed diabetes among adults aged 20 years or older, United States, 2004 and 2021

Incidence of newly diagnosed diabetes

Incidence among adults

Among U.S. adults aged 18 years or older, crude estimates for 2021 were:

• 1.2 million new cases of diabetes—or 5.9 per 1,000 people—were diagnosed (Table 3).
• Compared to adults aged 18 to 44 years, incidence rates of diagnosed diabetes were higher among adults aged 45 to 64 years and those aged 65 years and older (Table 3).

Among U.S. adults aged 18 years or older, age-adjusted data for 2019–2021 indicated:

• Compared to non-Hispanic White adults and Asian adults, incidence estimates were higher for non-Hispanic Black adults and Hispanic adults (Appendix Table 4).
• Incidence rates of diagnosed diabetes were higher among those with less than high school education and those with high school education only compared to adults with more than high school education (Appendix Table 4).
• Incidence was similar among adults living in metropolitan and nonmetropolitan areas (Appendix Table 4).

Table 3. Estimated crude incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2019–2021

CI = confidence interval.

a Population estimates for 2021 were derived from rates for 2019–2021 applied to July 1, 2021 U.S. resident population estimates from the U.S. Census Bureau (See Appendix B: Detailed Methods).

b Rates were calculated using 2021 data only.

Data sources: 2019–2021 National Health Interview Survey and 2021 U.S. Census Bureau data.

Trends in incidence among adults

• Among adults aged 18 years or older, the age-adjusted incidence of diagnosed diabetes was similar in 2000 (6.2 per 1,000 adults) and 2021 (5.8 per 1,000 adults). A significant decreasing trend in incidence was detected after 2008 (8.4 per 1,000 adults) through 2021. (Figure 4).

Figure 4. Trends in age-adjusted incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2000–2021

Notes: Data shown are estimated incidence rates (solid blue line) and 95% confidence intervals (shaded). Joinpoint identified in 2008 (see Appendix B: Detailed Methods and Data Sources). Because of changes to the survey design and survey instruments after 2018, comparisons of the 2000–2018 and 2019–2021 data should be examined with caution.

County-level incidence among adults

Among US adults aged 20 years or older, age-adjusted, county-level data indicated:

• Estimates of diagnosed diabetes incidence varied across U.S. counties, ranging from 2.2 to 53.5 per 1,000 people in 2020 (for more detail, see U.S. Diabetes Surveillance System).
• Median county-level incidence of diagnosed diabetes was 9.7 and 9.0 per 1,000 people in 2004 and 2020, respectively (for more detail, see U.S. Diabetes Surveillance System).

Incidence among children and adolescents

Data from the SEARCH for Diabetes in Youth study indicated that, during 2017–2018, the estimated annual number of newly diagnosed cases in the United States included:

• 18,169 children and adolescents younger than age 20 years with type 1 diabetes.
• 5,293 children and adolescents aged 10 to 19 years with type 2 diabetes.

Trends in incidence among children and adolescents

Among U.S. children and adolescents aged younger than 20 years, modeled data in Figure 5 showed:

• For the period 2002–2018, overall incidence of type 1 diabetes significantly increased.
• Non-Hispanic Asian or Pacific Islander children and adolescents had the largest significant increases in incidence of type 1 diabetes, followed by Hispanic and non-Hispanic Black children and adolescents.
• Non-Hispanic White children and adolescents had the highest incidence of type 1 diabetes across all years.

Among U.S. children and adolescents aged 10 to 19 years, modeled data in Figure 5 showed:

• For the entire period 2002–2018, overall incidence of type 2 diabetes significantly increased.
• Incidence of type 2 diabetes significantly increased for all racial and ethnic groups, especially Asian or Pacific Islander, Hispanic, and non-Hispanic Black children and adolescents.
• Non-Hispanic Black children and adolescents had the highest incidence of type 2 diabetes across all years.

Figure 5. Trends in incidence of type 1 and type 2 diabetes in children and adolescents, overall and by race and ethnicity, 2002–2018

Note: Adapted from Wagenknecht LE et al 1 . Data are model-adjusted incidence estimates (see Appendix B: Detailed Methods and Data Sources).

Prevalence of prediabetes among adults

• An estimated 97.6 million adults aged 18 years or older had prediabetes in 2021 (Table 4).
• Among U.S. adults aged 18 years or older, crude estimates for 2017–2020 were:
  • 38.0% of all U.S. adults had prediabetes, based on their fasting glucose or A1C level (Table 4).
  • 19.0% of adults with prediabetes reported being told by a health professional that they had this condition (Table 4).

  Among U.S. adults aged 18 years or older, age-adjusted data for 2017–2020 indicated:

  • 10.8% of adults had prediabetes, based on both elevated fasting plasma glucose and A1C levels (Appendix Table 5).
  • A higher percentage of men (41.0%) than women (32.0%) had prediabetes, based on their fasting glucose or A1C level (Appendix Table 6).
  • Prevalence of prediabetes (based on fasting glucose or A1C level) was similar among all racial and ethnic groups and education levels (Appendix Table 6).

  Table 4. Estimated number, percentage, and awareness of prediabetes a among adults aged 18 years or older, United States, 2017–2020 and 2021

  Characteristic	Prediabetes, a 2021 Estimates Number in Millions (95% CI)	Prediabetes, a 2017–2020 Estimates Percentage (95% CI)	Prediabetes Awareness, b 2017–2020 Estimates Percentage (95% CI)
  Total	97.6 (91.9–103.2)	38.0 (35.7-40.3)	19.0 (15.0-23.7)
  Age in years
  18–44	32.8 (28.2–37.4)	27.8 (24.0-32.0)	13.8 (9.8–18.9)
  45–64	37.5 (35.1–40.0)	44.8 (41.7–47.9)	20.6 (14.3–28.9)
  ≥65	27.2 (24.9–29.6)	48.8 (44.3–53.2)	23.0 (16.9–30.4)
  Sex
  Men	53.2 (48.9–57.6)	41.9 (38.4–45.6)	17.4 (13.4–22.2)
  Women	44.3 (40.4–48.3)	34.3 (31.2–37.5)	20.9 (15.5–27.5)
  Race-Ethnicity
  White, non-Hispanic	61.8 (59.6–66.7)	38.7 (35.5–41.9)	17.3 (11.8–24.7)
  Black, non-Hispanic	12.3 (11.3–13.3)	39.2 (35.8–42.6)	21.9 (18.0–26.5)
  Asian, non-Hispanic	5.8 (5.1–6.6)	37.3 (32.6–42.3)	30.1 (21.0–41.1)
  Hispanic	15.0 (13.7–16.3)	34.5 (31.3–37.7)	20.9 (15.3–27.9)

  Notes: CI = confidence interval. Data are crude estimates (see Appendix B: Detailed Methods and Data Sources). Time period 2017–2020 covers January 2017 through March 2020 only.

  a Prediabetes was defined as fasting plasma glucose values of 100 to 125 mg/dL or A1C values of 5.7% to 6.4%.

  b Prediabetes awareness was based on self-report and estimated only among adults with prediabetes.

  Data sources: 2017–March 2020 National Health and Nutrition Examination Survey; 2021 U.S. Census Bureau data.

  Trends in prevalence of prediabetes among adults

  • There were no significant changes in age-adjusted prevalence of prediabetes from 2005–2008 to 2017–2020 (Appendix Table 7). About one-third of U.S. adults had prediabetes over the entire period.
  • Among adults with prediabetes, the age-adjusted percentage aware that they had this condition increased from 6.5% in 2005–2008 to 17.4% in 2017–2020 (Appendix Table 7).

  Risk factors for diabetes-related complications

  Among U.S. adults aged 18 years or older with diagnosed diabetes, crude estimates for 2017–2020 shown in Appendix Table 8 were:

  Smoking

  • 22.1% were tobacco users based on self-report or levels of serum cotinine.
  • 14.6% reported current cigarette smoking.
  • 36.0% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime.

  Overweight and obesity

  • 89.8% were overweight or had obesity, defined as a body mass index (BMI) of 25 kg/m 2 or higher. Specifically
    • 26.9% were overweight (BMI of 25.0 to 29.9 kg/m 2 ).
    • 47.1% had obesity (BMI of 30.0 to 39.9 kg/m 2 ).
    • 15.7% had extreme obesity (BMI of 40.0 kg/m 2 or higher).

    Physical inactivity

    • 31.9% were physically inactive, defined as getting less than 10 minutes a week of moderate or vigorous activity in each physical activity category of work, leisure time, and transportation.

    A1C

    • 47.4% had an A1C value of 7.0% or higher. Specifically:
      • 22.9% had an A1C value of 7.0% to 7.9%.
      • 11.5% had an A1C value of 8.0% to 9.0%.
      • 13.0% had an A1C value higher than 9.0%.

      High blood pressure

      • 80.6% had a systolic blood pressure of 130 mmHg or higher or diastolic blood pressure of 80 mmHg or higher or were on prescription medication for their high blood pressure (Appendix Table 8).
      • 70.8% had a systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher or were on prescription medication for their high blood pressure (Appendix Table 8).

      High cholesterol*

      • 39.5% had a non-HDL level of 130 mg/dL or higher. Specifically:
        • 19.9% had a non-HDL level of 130 to 159 mg/dL.
        • 11.5% had a non-HDL level of 160 to 189 mg/dL.
        • 8.0% had a non-HDL level of 190 mg/dL or higher.

        * Non-high-density lipoprotein cholesterol (non-HDL) contains all the atherogenic lipoproteins, including low-density lipoprotein cholesterol (LDL), very-low-density lipoprotein, lipoprotein(a), and others. Growing evidence supports non-HDL as a better predictor of cardiovascular disease risk than LDL 2 .

        Preventing diabetes-related complications

        Among U.S. adults aged 18 years or older with diagnosed diabetes, crude data for 2017–2020 shown in Appendix Table 10 indicated:

        Usual source for diabetes care

        • 78.8% reported having at least one usual source of diabetes care, such as a doctor or other health care professional.