Health Insurance
Nearly 1 in 10 US Adults Have Diabetes Diagnosis; Older People, Southerners Hardest Hit
Diabetes can be deadly — and it’s unfortunately a disease that's not uncommon. According to ValuePenguin research, 8.8% of Americans 18 and older have a diabetes diagnosis as of 2024. But the disease doesn't affect everyone equally, with Hispanic and Black Americans suffering higher rates of diabetes than average. Rates also vary by state, with Southern states disproportionally represented.
While diabetes is treatable, required care can be costly, and is becoming more so. Our study found that from 2000 to 2022, spending on diabetes surged 769%. Below, find details on our full findings about the state of diabetes in the U.S. today.
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Key findings
- 8.8% of Americans 18 and older have a diabetes diagnosis as of 2024. That’s a 0.6 percentage point increase from 2020, when the diagnosis rate was 8.2%.
- Diabetes doesn’t affect everyone equally. By race, Hispanic (12.6%) and Black (11.7%) Americans have the highest diabetes diagnosis rates. Meanwhile, older adults are significantly more likely to have received a diagnosis than any other age group, at 21.6% among those 75 and older. Those ages 65 to 74 follow, at 19.9%.
- West Virginia has the highest diabetes diagnosis rate. 15.0% of the state's adult population is affected, ahead of fellow Southern states Mississippi (14.7%) and Louisiana (14.5%). Meanwhile, Vermont (7.7%), New Hampshire (7.9%) and Montana (7.9%) have the lowest rates.
- South Dakota saw the largest increase in diabetes diagnosis rates between 2020 and 2023, the latest available by state. In South Dakota, the diabetes diagnosis rate rose by 3.5 percentage points. Wyoming and West Virginia tied for second, at 1.9 points each. Just eight states saw either a decrease or no change in diabetes diagnosis rates during this period.
- Spending on diabetes has surged 769% since 2000. Direct costs were $18.3 billion in 2000, compared to nearly $159 billion in 2022 — the latest year with spending data available. Per person, direct costs rose from $1,543 to $6,003 annually during the period. Also, the percentage of diabetics who only use insulin fell from 25.6% to 20.1%, while the percentage of those who use insulin as well as pills rose from 11.2% to 16.9%.
8.8% of American adults have diabetes diagnosis
Overall, 8.8% of American adults ages 18 and older had a diabetes diagnosis in 2024. That’s nearly 1 in 10. The rate is up from 8.2% in 2020, the first year of the coronavirus pandemic — and up from just 6.0% in 2000.
The World Health Organization (WHO) points to factors like increasing obesity rates, the marketing of unhealthy foods, sedentary lifestyles and economic hardships as trends supporting the increase in diabetes — which is a problem not just in America, but globally. The WHO also mentions "widening treatment gaps," especially for low- and middle-income countries, which keep many of these adults from getting the life-saving treatment they need.
The same pattern is noticeable here at home, where historically disadvantaged racial groups suffer the highest rates of diagnosed diabetes. Our study finds that 12.6% of Hispanic Americans had a diabetes diagnosis in 2024 — nearly four full percentage points higher than the national average. Meanwhile, 11.7% of Black Americans live with diabetes.
Older Americans, too, are harder hit by diabetes, with the diabetes rate steadily climbing along with age. Americans ages 75 and older saw the highest rate (21.6%), followed by those 65 to 74 (19.9%), 45 to 64 (12.9%) and 18 to 44 (2.6%).
Diabetes rates also vary with education level, with the highest rate (13.8%) among Americans who hadn’t finished high school and the lowest rate (7.2%) among those who had finished a level of education beyond high school. By sex, though, females have a slight advantage over males, with overall diabetes rates of 8.3% and 9.3%, respectively.
The reasons? Multifaceted, says Talon Abernathy, ValuePenguin health insurance expert.
"A lack of preventive care may play a partial, if incomplete, role in explaining these differences," he explains. "According to a 2024 study by the Urban Institute, Hispanic adults were significantly less likely to receive diabetes screening than other demographics. However, Black Americans were more likely to get diabetes screenings than their white counterparts. That higher screening rate may reflect a push by the health care industry to meet this demographic-specific need."
Along with variance when it comes to screenings, lack of insurance is another problem for many underprivileged demographics. "Other research reveals that Hispanics and African Americans are more likely to be uninsured than white and Asian Americans," Abernathy says. "Moreover, African Americans, in particular, face persistent barriers in accessing health care compared to other demographics. When they're able to get care, the quality is often poor."
Southern states have highest diabetes diagnosis rates
Along with the demographics discussed already, diabetes rates also vary by state — and Southern states bear the brunt. West Virginia has the highest rate of diabetes in the nation at 15.0%, followed by Mississippi (14.7%), Louisiana (14.5%), Alabama (13.7%) and Arkansas (13.0%).
The classic cuisine of the South — where biscuits and gravy breakfasts might be followed by fried-chicken dinners — may play a part in the trend. But so might poverty levels, which can limit residents’ access to healthier food options and also preventive medical care. Each of the top five states has a lower median household income than the national average.
Abernathy also points out that two of these top-five states, Mississippi and Alabama, don’t have expanded Medicaid programs. "That means a good portion of the most vulnerable citizens in those states may not have access to any form of affordable health insurance whatsoever," he says.
At the other end of the spectrum, Vermont, New Hampshire and Montana are the only states in the country with a diabetes rate lower than 8.0%. A total of 10 states, plus the District of Columbia, have a diabetes rate lower than 8.8%, the national average for 2024. (Note that at the state level, 2023’s data is the latest available.)
Since state diabetes rates are affected by a wide range of factors, such as local income, food culture and car-dependent infrastructure, Abernathy explains that, "unfortunately, health insurance companies can't bring about wholesale change."
Still, there are steps they can take to address the problem of diabetes — in any state. "Insurance companies should start by emphasizing the importance of lifestyle changes, early detection and prevention," Abernathy goes on. "Sending reminders to customers to get regular screenings and other preventive care is a good start. Incentives such as cheaper wellness rates for customers who complete an annual checkup and reimbursing gym memberships and personalized dietitian appointments can help."
Full rankings: States with highest/lowest diabetes diagnosis rates
Rank | State | % |
|---|---|---|
| 1 | West Virginia | 15.0% |
| 2 | Mississippi | 14.7% |
| 3 | Louisiana | 14.5% |
| 4 | Alabama | 13.7% |
| 5 | Arkansas | 13.0% |
| 6 | Kentucky | 12.9% |
| 7 | Tennessee | 12.7% |
| 8 | South Carolina | 12.6% |
| 9 | Texas | 12.0% |
| 10 | Indiana | 11.5% |
| 11 | Georgia | 11.4% |
| 12 | Ohio | 11.3% |
Source: ValuePenguin analysis of 2023 Centers for Disease Control and Prevention (CDC) United States Diabetes Surveillance System data. Note: Data covers adults 18 and older.
Diabetes diagnosis rates rose most in South Dakota
Our study also tracked the change in diabetes rates by state between 2020 and 2023, finding that diabetes diagnoses in South Dakota rose 3.5 percentage points over that time frame — more than any other state in the nation. Other states with relatively high increases included Wyoming and West Virginia (tied for 1.9 percentage points), Wisconsin and Louisiana (tied for 1.8 points), Maryland (1.7 points) and Mississippi (1.6 points). Meanwhile, diabetes diagnosis rates fell in a total of six states plus the District of Columbia, and remained the same in Hawaii.
While it’s difficult to ascertain why certain states saw increases in diabetes diagnoses and others saw decreases, it’s worth noting that the overall population of South Dakota has been on the rise since 2020. Although the rate is across the population (and therefore not immediately affected by additional residents), having an influx of people from out-of-state (and potentially higher-diabetes-rate states) could be one reason more South Dakotans have diabetes.
Full rankings: States with biggest increases/decreases in diabetes diagnosis rates
Rank | State | %, 2020 | %, 2023 | Change (points) |
|---|---|---|---|---|
| 1 | South Dakota | 7.0% | 10.5% | 3.5 |
| 2 | Wyoming | 7.5% | 9.4% | 1.9 |
| 2 | West Virginia | 13.1% | 15.0% | 1.9 |
| 4 | Wisconsin | 7.6% | 9.4% | 1.8 |
| 4 | Louisiana | 12.7% | 14.5% | 1.8 |
| 6 | Maryland | 9.1% | 10.8% | 1.7 |
| 7 | Mississippi | 13.1% | 14.7% | 1.6 |
| 8 | Minnesota | 7.8% | 9.3% | 1.5 |
| 8 | Illinois | 9.3% | 10.8% | 1.5 |
| 8 | Kentucky | 11.4% | 12.9% | 1.5 |
| 11 | Arkansas | 11.7% | 13.0% | 1.3 |
| 11 | California | 9.2% | 10.5% | 1.3 |
Source: ValuePenguin analysis of 2020 and 2023 CDC United States Diabetes Surveillance System data. Note: Data covers adults 18 and older.
Diabetes spending has increased significantly since 2000
While diabetes is, fortunately, treatable, treating the disease and its complications can be costly. Indeed, diabetes spending has risen a whopping 769% between 2000 and 2022, the latest year for which such data is available. At the turn of the millennium, direct costs were $18.3 billion, compared with $159 billion in 2022.
How does that translate to spending per person? In 2022, direct costs were $6,003 per year for each diabetes patient, compared to just $1,543 in 2000. (Even accounting for inflation, that’s a significant increase, as $1,543 in 2000 dollars equals $2,961 in 2025 dollars.)
"Fortunately for most people with diabetes," says Abernathy, "this increased per-person spending won't have a direct impact on their health insurance cost or coverage. That's because insurance companies aren't allowed to discriminate against patients based on their health status or preexisting conditions. Plus, all regular health insurance plans have to include coverage for diabetes because it qualifies as an essential health benefit."
But, Abernathy warns, that requirement doesn’t apply to short-term health insurance. "It's a good idea to avoid these plans because they can charge you more or deny coverage outright because of your health status."
Meanwhile, the way patients treat their diabetes has also changed over time. In 2000, 45.6% of diabetes patients used only pills to treat their condition, while 25.6% used only insulin, and 11.2% of patients used both. These days, more patients seem to be taking a multipronged treatment approach, with 16.9% of patients on both insulin and pills in 2023, the last year for which CDC data is available. (That year, 46.5% were on only pills and 20.1% on only insulin.)
Fewer diabetics were unmedicated in 2023 (16.5%) than back in 2000 (17.6%).
Medication rates among diabetics by type and year
Year | % using pills only | % using insulin only | % using insulin/pills | % not using medication |
|---|---|---|---|---|
| 2000 | 45.6% | 25.6% | 11.2% | 17.6% |
| 2001 | 49.9% | 19.7% | 10.4% | 20.0% |
| 2002 | 49.5% | 17.1% | 12.9% | 20.4% |
| 2003 | 48.6% | 21.6% | 11.6% | 18.2% |
| 2004 | 49.9% | 17.8% | 11.8% | 20.5% |
| 2005 | 49.7% | 17.7% | 12.9% | 19.7% |
| 2006 | 49.9% | 15.3% | 11.7% | 23.1% |
| 2007 | 51.3% | 15.0% | 11.2% | 22.5% |
| 2008 | 45.9% | 16.0% | 13.6% | 24.5% |
| 2009 | 49.5% | 15.7% | 11.9% | 22.9% |
| 2010 | 48.1% | 17.9% | 13.7% | 20.3% |
| 2011 | 52.7% | 17.7% | 12.1% | 17.5% |
Source: ValuePenguin analysis of CDC United States Diabetes Surveillance System data. Note: Data covers adults 18 and older.
Navigating diabetes treatment costs: Top expert tips
Diabetes-related health care can be costly — but it doesn’t have to break the bank. Here are our top expert tips for navigating diabetes treatment costs.
- Take advantage of covered health services. "Remember that you don’t need to hit your annual deductible to get coverage for preventive services," Abernathy says. "In fact, the Affordable Care Act (ACA), sometimes called Obamacare, requires health plans to cover diabetes screening with zero cost sharing. That means you won't pay anything to get tested for diabetes."
- Talk to your insurance company directly. You can call and ask if the company offers "first-dollar" or predeductible coverage for diabetes medications, including insulin, Abernathy explains. "If they do, you may get coverage immediately without having to meet your deductible first. Keep in mind, this benefit is nonstandard, so not all plans offer it."
- Stay in-network. No matter what illness you’re treating, "you’ll pay substantially less when you go to doctors in your plan's network," Abernathy says.
- Check your plan’s formulary — i.e., its list of approved drugs. "Coverage will vary by drug type and whether you choose a brand name or generic version of the medication," Abernathy explains. "When possible, use a generic for the cost savings. If you don't have coverage for the drugs you need, consider getting a copay card or using a coupon service such as GoodRx."
- If you’re on Medicare, check your coverage. Original Medicare (Parts A and B) covers only limited diabetes supplies, while you can get full coverage with Medicare Part D. Note: Several diabetes medications are part of the Medicare drug price negotiation.
Methodology
To rank the states with the highest diabetes diagnosis rates, researchers analyzed Centers for Disease Control and Prevention (CDC) United States Diabetes Surveillance System data.
Specifically, we compared states based on their 2023 age-adjusted diabetes rates. We then examined changes over time by identifying where diabetes diagnoses increased the most between 2020 and 2023.
In addition, we drew on Medical Expenditure Panel Survey Household Component (MEPS-HC) data to assess how direct spending on diabetes has evolved over time.
