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`Diabetes
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`National Diabetes Statistics Report
`Estimates of Diabetes and Its Burden in the United States
`
`Introduction
`
`The National Diabetes Statistics Report provides up-to-date information on the prevalence and incidence of diabetes and
`prediabetes, risk factors for complications, acute and long-term complications, deaths, and costs.
`
`Data in the report can help focus efforts to prevent and control diabetes across the United States. This report is continually
`updated as data become available.
`
`This report fulfills the requirement mandated by the Catalyst to Better Diabetes Care Act of 2009 (Section 10407 of Public Law
`111-148).
`
`Information about the methods is available here and appendix with tables and methods.
`Fast Facts on Diabetes
`
`Diabetes
`Total: 38.4 million people have diabetes (11.6% of the US population)
`Diagnosed: 29.7 million people, including 29.4 million adults
`Undiagnosed: 8.7 million people (22.8% of adults are undiagnosed)
`
`Prediabetes
`Total: 97.6 million people aged 18 years or older have prediabetes (38.0% of the adult US population)
`65 years or older: 27.2 million people aged 65 years or older (48.8%) have prediabetes
`
`Results
`
`Prevalence of Both Diagnosed and Undiagnosed Diabetes
`
`Among the US population overall, crude estimates for 2021 were:
`
`38.4 million people of all ages—or 11.6% of the US population—had diabetes.
`38.1 million adults aged 18 years or older—or 14.7% of all US 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 US adults (Table 1a) and 22.8%
`of all US adults with diabetes.
`The percentage of adults with diabetes increased with age, reaching 29.2% among those aged 65 years or older (Table
`1a).
`
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`

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`Table 1a. Estimated crude prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults
`aged 18 years or older, United States, 2017–2020
`
`Characteristic
`
`Diagnosed diabetes
`Percentage
`(95% CI)
`
`Undiagnosed diabetes
`Percentage
`(95% CI)
`
`Total diabetes
`Percentage
`(95% CI)
`
`Total
`
`11.3 (10.3–12.5)
`
`3.4 (2.7–4.2)
`
`14.7 (13.2–16.4)
`
`Age in years
`
`18–44
`
`45–64
`
`≥65
`
`Sex
`
`Men
`
`3.0 (2.4–3.7)
`
`14.5 (12.2–17.0)
`
`24.4 (22.1–27.0)
`
`12.6 (11.1–14.3)
`
`Women
`
`10.2 (8.8–11.7)
`
`1.9 (1.3–2.7)
`
`4.5 (3.3–6.0)
`
`4.7 (3.0–7.4)
`
`2.8 (2.0–3.9)
`
`3.9 (2.7–5.5)
`
`4.8 (4.0–5.9)
`
`18.9 (16.1–22.1)
`
`29.2 (26.4–32.1)
`
`15.4 (13.5–17.5)
`
`14.1 (11.8–16.7)
`
`Race-Ethnicity
`
`White, non-
`Hispanic
`
`11.0 (9.4–12.8)
`
`2.7 (1.7–4.2)
`
`13.6 (11.4–16.2)
`
`Black, non-Hispanic
`
`12.7 (10.7–15.0)
`
`Asian, non-Hispanic
`
`11.3 (9.7–13.1)
`
`Hispanic
`
`11.1 (9.5–13.0)
`
`4.7 (3.3–6.5)
`
`5.4 (3.5–8.3)
`
`4.4 (3.3–5.8)
`
`17.4 (15.2–19.8)
`
`16.7 (14.0–19.8)
`
`15.5 (13.8–17.3)
`
`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
`
`Characteristic
`
`Diagnosed diabetes Number in
`Millions (95% CI)
`
`Undiagnosed diabetes
`Number in Millions
`(95% CI)
`
`Total diabetes Number in
`Millions (95% CI)
`
`Total
`
`29.4 (26.7–32.0)
`
`8.7 (7.0–10.5)
`
`38.1 (34.2–42.0)
`
`Age in years
`
`18–44
`
`45–64
`
`≥65
`
`3.5 (2.8–4.2)
`
`12.0 (10.1–13.9)
`
`13.8 (12.5–15.1)
`
`2.2 (1.5–3.0)
`
`3.8 (2.7–4.8)
`
`2.7 (1.6–3.8)
`
`5.8 (4.7–6.8)
`
`15.8 (13.4–18.2)
`
`16.5 (15.0–18.1)
`
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`Characteristic
`
`Diagnosed diabetes Number in
`Millions (95% CI)
`
`Undiagnosed diabetes
`Number in Millions
`(95% CI)
`
`Total diabetes Number in
`Millions (95% CI)
`
`Sex
`
`Men
`
`16.1 (14.1–18.0)
`
`Women
`
`13.3 (11.5–15.1)
`
`3.7 (2.6–4.8)
`
`5.0 (3.3–6.7)
`
`19.8 (17.4–22.1)
`
`18.3 (15.3–21.3)
`
`Race-Ethnicity
`
`White, non-
`Hispanic
`
`Black, non-
`Hispanic
`
`Asian, non-
`Hispanic
`
`17.8 (15.2–20.4)
`
`4.3 (2.4–6.1)
`
`22.1 (18.5–25.7)
`
`4.0 (3.3–4.6)
`
`1.4 (1.0–1.9)
`
`5.4 (4.7–6.1)
`
`1.8 (1.5–2.1)
`
`0.9 (0.5–1.2)
`
`2.7 (2.2–3.1)
`
`Hispanic
`
`5.0 (4.3–5.7)
`
`1.9 (1.4–2.4)
`
`6.9 (6.2–7.6)
`
`Notes: CI = confidence interval. Estimated numbers for 2021 were derived from percentages for 2017–March 2020 applied to July 1, 2021, US resident
`population estimates from the US Census Bureau (See Detailed Methods). 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 US 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
`
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`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.
`Data sources: 2001–March 2020 National Health and Nutrition Examination Surveys.
`
`Prevalence of Diagnosed Diabetes
`
`Among the US population overall, crude estimates for 2021 were:
`
`29.7 million people of all ages—or 8.9% of the US population—had diagnosed diabetes.
`352,000 children and adolescents younger than age 20 years—or 35 per 10,000 US 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 US 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 US adults with diagnosed diabetes—started using insulin
`within a year of their diagnosis.
`
`Among US 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
`
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`

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`Note: Error bars represent upper and lower bounds of the 95% confidence interval.
`Data source: 2019–2021 National Health Interview Survey.
`
`Among US adults aged 18 years or older, crude data for 2019–2021 (Table 2; see Detailed Methods) indicated the
`following:
`
`Native Hawaiian or Other Pacific Islander adults had a prevalence of 11.7%.
`Among non-Hispanic Asian adults, Asian Indian (10.8%) and Filipino (12.2%) subgroups had the highest prevalence.
`Chinese, Japanese, Korean, and Vietnamese subgroups had prevalences ranging from 6.1% to 7.1%. Other Asian
`groups combined had a prevalence of 8.9%.
`Among adults of Hispanic origin, Puerto Rican (13.3%) and Mexican or Mexican American (11.1%) adults had the
`highest prevalence, followed by Dominican (9.4%) and Cuban (9.0%) adults. Central American, South American, and
`other Hispanic, Latino, or Spanish adults had prevalences ranging from 5.0% to 7.3%.
`
`Table 2. Crude prevalence of diagnosed diabetes by detailed race and ethnicity among adults aged 18 years or older,
`United States, 2019–2021
`
`Race and Ethnicity Subgroup
`
`Total Percentage (95% CI) 
`
`American Indian or Alaska Native, non-Hispanic
`
`Black, non-Hispanic
`
`Native Hawaiian or Other Pacific Islander, non-Hispanic
`
`Asian, non-Hispanic
`
`Asian Indian, non-Hispanic
`
`Chinese, non-Hispanic
`
`Filipino, non-Hispanic
`
`Japanese, non-Hispanic
`
`Korean, non-Hispanic
`
`Vietnamese, non-Hispanic
`
`Other Asian, non-Hispanic
`
`Hispanic
`
`16.0 (12.1–20.6)
`
`12.5 (11.6–13.4)
`
`11.7 (7.4–17.2)
`
`9.2 (8.2–10.4)
`
`10.8 (8.3–13.7)
`
`7.1 (5.2–9.3)
`
`12.2 (9.4–15.6)
`
`6.8 (4.1–10.5)
`
`6.1 (3.8–9.1)
`
`6.4 (3.7–10.0)
`
`8.9 (5.9–12.8)
`
`10.3 (9.4–11.1)
`
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`Race and Ethnicity Subgroup
`
`Mexican or Mexican American
`
`Central American
`
`South American
`
`Puerto Rican
`
`Cuban
`
`Dominican
`
`Other Hispanic, Latino, or Spanish
`
`White, non-Hispanic
`
`Total Percentage (95% CI) 
`
`11.1 (9.9–12.3)
`
`7.3 (5.6–9.4)
`
`5.0 (3.3–7.1)
`
`13.3 (11.0–15.9)
`
`9.0 (6.5–12.1)
`
`9.4 (5.9–14.2)
`
`7.2 (5.5–9.2)
`
`8.5 (8.2–8.8)
`
`Note: CI = confidence interval.
`Data sources: National Center for Health Statistics; 2019–2021 National Health Interview Survey.
`
`County-Level Prevalence Among Adults
`Among US adults aged 20 years or older, age-adjusted, county-level data indicated:
`
`In 2021, estimates of diagnosed diabetes prevalence varied across US 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
`
`Data sources: US Diabetes Surveillance System; Behavioral Risk Factor Surveillance System. On the 2021 map, 2020 data were used for Florida because
`2021 data were unavailable.
`
`Incidence of Newly Diagnosed Diabetes
`
`Incidence Among Adults
`Among US 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 US adults aged 18 years or older, age-adjusted data for 2019–2021 indicated:
`
`MPI EXHIBIT 1115 PAGE 6
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`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
`
`Characteristic
`
`Population Estimates, 2021
`a
`Number in Thousands (95% CI)
`
`Incidence Estimates, 2019–2021
`Rate per 1,000 (95% CI)
`
`1,211 (1,094–1,328)
`
`5.9 (5.1–6.9)
`
`b
`
`Total
`
`Age in years
`
`18–44
`
`45–64
`
`≥65
`
`Sex
`
`Men
`
`Women
`
`Race/ethnicity
`
`305 (241–369)
`
`633 (550–716)
`
`273 (222–325)
`
`620 (536–704)
`
`591 (510–672)
`
`3.0 (2.1–4.2)
`
`b
`
`10.1 (8.2–12.4)
`
`b
`
`6.8 (5.1–8.9)
`
`b
`
`6.4 (5.2–7.9)
`
`b
`
`5.5 (4.4–6.9)
`
`b
`
`5.1 (4.5–5.8)
`
`6.8 (5.3–8.7)
`
`3.8 (2.4–5.9)
`
`6.1 (4.8–7.7)
`
`White, non-Hispanic
`
`721 (633–809)
`
`Black, non-Hispanic
`
`185 (139–232)
`
`Asian, non-Hispanic
`
`52 (29–76)
`
`Hispanic
`
`233 (178–289)
`
`CI = confidence interval.
` Population estimates for 2021 were derived from rates for 2019–2021 applied to July 1, 2021 US resident population estimates from the US Census
`a
`Bureau (See Appendix B: Detailed Methods).
` Rates were calculated using 2021 data only.
`b
`Data sources: 2019–2021 National Health Interview Survey and 2021 US 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
`
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`

`

`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.
`Data source: 2000–2021 National Health Interview Survey.
`
`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 US counties, ranging from 2.2 to 53.5 per 1,000 people in
`2020 (for more detail, see US 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 US 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 US 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 US 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.
`
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`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. Data are model-adjusted incidence estimates (see Appendix B: Detailed Methods and Data Sources).
`1
`Data source: SEARCH for Diabetes in Youth study.
`
`Prevalence of Prediabetes Among Adults
`
`An estimated 97.6 million adults aged 18 years or older had prediabetes in 2021 (Table 4).
`Among US adults aged 18 years or older, crude estimates for 2017–2020 were:
`38.0% of all US 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 US 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 among adults aged 18 years or older, United
`a
`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,
`2017–2020 Estimates
`Percentage (95% CI)
`
`b
`
`Total
`
`97.6 (91.9–103.2)
`
`38.0 (35.7-40.3)
`
`19.0 (15.0-23.7)
`
`Age in years
`
`18–44
`
`45–64
`
`≥65
`
`Sex
`
`32.8 (28.2–37.4)
`
`27.8 (24.0-32.0)
`
`13.8 (9.8–18.9)
`
`37.5 (35.1–40.0)
`
`44.8 (41.7–47.9)
`
`20.6 (14.3–28.9)
`
`27.2 (24.9–29.6)
`
`48.8 (44.3–53.2)
`
`23.0 (16.9–30.4)
`
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`Prediabetes,
`a
`2021 Estimates
`Number in Millions (95% CI)
`
`Prediabetes,
`a
`2017–2020 Estimates
`Percentage (95% CI)
`
`Prediabetes Awareness,
`2017–2020 Estimates
`Percentage (95% CI)
`
`b
`
`53.2 (48.9–57.6)
`
`41.9 (38.4–45.6)
`
`17.4 (13.4–22.2)
`
`44.3 (40.4–48.3)
`
`34.3 (31.2–37.5)
`
`20.9 (15.5–27.5)
`
`Characteristic
`
`Men
`
`Women
`
`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.
` Prediabetes was defined as fasting plasma glucose values of 100 to 125 mg/dL or A1C values of 5.7% to 6.4%.
`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 US Census Bureau data.
`
`a b
`
`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 US 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 US 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  or higher. Specifically:
`2
`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  or higher).
`2
`
`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%.
`
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`13.0% had an A1C value higher than 9.0%.
`10.4% of adults aged 18–44 years had A1C levels of 10% or higher, compared to 9.4% of those aged 45–64 years and
`2.6% of those aged 65 years or older (Appendix Table 9).
`
`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 US 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.
`
`Physical Activity
`24.1% met the recommended goal of at least 150 minutes per week of leisure-time physical activity.
`
`Weight Management
`73.1% reported managing or losing weight to lower their risk for developing certain diseases.
`
`Statin Treatment
`57.8% of adults aged 40–75 years were on statin therapy.
`
`A1C, Blood Pressure, Cholesterol, and Smoking (ABCs)
`11.1% met all these criteria: A1C value <7.0%, blood pressure <130/80 mmHg, non-HDL cholesterol <130 mg/dL, and
`being a nonsmoker (Table 5).
`36.8% met all these criteria: A1C value <8.0%, blood pressure <140/90 mmHg, non-HDL cholesterol <160 mg/dL, and
`being a nonsmoker (Table 5).
`
`Table 5. Crude percentage of adults aged 18 years or older with diagnosed diabetes meeting all ABCs goals,
`States, 2017–2020
`
`3–4
`
` United
`
`Risk Factor
`
`ABCs goals for many adults
`
`Less stringent ABCs goals
`
`A1C
`
`Blood Pressure
`
`<7.0%
`
`<8.0%
`
`<130/80 mmHg
`
`<140/90 mmHg
`
`MPI EXHIBIT 1115 PAGE 11
`
`

`

`Risk Factor
`
`ABCs goals for many adults
`
`Less stringent ABCs goals
`
`Cholesterol, non-HDL
`
`Smoking, current
`
`<130 mg/dL
`
`Nonsmoker
`
`<160 mg/dL
`
`Nonsmoker
`
`Percentage meeting all ABCs goals
`
`11.1 (8.1–14.9)
`
`36.8 (31.8–42.1)
`
`Notes: ABCs = A1C, blood pressure, cholesterol, and smoking. CI = confidence interval. Estimates are crude percentages and 95% confidence intervals.
`Data source: 2017–2020 National Health and Nutrition Examination Survey.
`
`Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2021 indicated:
`
`87.9% (95% CI, 86.4–89.3) received all three recommended ABC tests by a health professional in the past year.
`94.2% (95% CI, 93.0–95.2) received a blood test for A1C in the past year.
`96.8% (95% CI, 95.8–97.5) had their blood pressure checked.
`93.0% (95% CI, 91.8–94.1) had their cholesterol checked.
`Vaccinations (See Appendix B: Detailed Methods)
`Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2021 indicated:
`
`65.9% (95% CI, 63.8–68.0) had received an influenza vaccination in the past year.
`81.5% (95% CI, 79.4–83.4) had ever received a COVID-19 vaccination.
`8.9% (95% CI, 7.6–10.4) had received one COVID-19 vaccination.
`63.8% (95% CI, 61.5–66.1) had received two COVID-19 vaccinations.
`8.7% (95% CI, 7.6–10.1) had received more than two COVID-19 vaccinations.
`26.2% (95% CI, 24.2–28.3) had ever received a hepatitis B vaccination.
`35.9% (95% CI, 32.2–39.8) of adults aged 18–59 years had ever received a hepatitis B vaccination.
`50.7% (95% CI, 48.6–52.9) had ever received a pneumococcal vaccination.
`
`Coexisting Conditions and Complications
`
`Emergency Department Visits
`In 2020, about 16.8 million emergency department (ED) visits were reported with diabetes as any listed diagnosis among
`adults aged 18 years or older (Table 6), including:
`
`267,000 for hyperglycemic crisis (11.4 per 1,000 adults with diabetes).
`202,000 for hypoglycemia (8.6 per 1,000 adults with diabetes).
`
`Table 6. Number and rate of emergency department visits per 1,000 adults aged 18 years or older with diabetes for
`selected causes, United States, 2019 and 2020
`
`Risk factor
`
`Diabetes as any listed
`diagnosis
`
`2019
`Number
`
`2019 Crude rate per
`1,000 (95% CI)
`
`2020
`Number
`
`2020 Crude Rate per
`1,000 (95% CI)
`
`17,939,000
`
`766.0 (708.8–823.2) 
`
`16,779,000 
`
`716.0 (663.0–770.0) 
`
`Hyperglycemic crisis
`
`255,000
`
`10.9 (10.1–11.7)
`
`267,000
`
`11.4 (10.5–12.3)
`
`Diabetic ketoacidosis
`
`229,000
`
`9.8 (9.1–10.5)
`
`240,000
`
`10.2 (9.4–11.0)
`
`MPI EXHIBIT 1115 PAGE 12
`
`

`

`Risk factor
`
`2019
`Number
`
`2019 Crude rate per
`1,000 (95% CI)
`
`2020
`Number
`
`2020 Crude Rate per
`1,000 (95% CI)
`
`Hyperosmolar hyperglycemic
`syndrome
`
`26,000
`
`1.1 (1.0–1.2)
`
`27,000
`
`1.2 (1.1–1.3)
`
`Hypoglycemia
`
`246,000
`
`10.5 (9.7–11.2)
`
`202,000
`
`8.6 (8.0–9.3)
`
`Note: CI = confidence interval. Numbers rounded to the nearest thousand. Data sources: 2019 and 2020 National Emergency Department Sample; 2019
`and 2020 National Health Interview Survey.
`
`In 2020, of the ED visits with diabetes as any listed diagnosis among US adults aged 18 years or older, disposition data
`(see Appendix B: Detailed Methods and Data Sources) indicated:
`
`54.9% were treated and released; 38.4% were admitted to the hospital; 2.5% were transferred to another hospital;
`2.6% were transferred to a skilled nursing facility, an intermediate care facility, or home with home health care; 1.3%
`left against medical advice; 0.3% died; and <0.1% had unknown disposition but were not admitted to a hospital.
`Of those ED visits involving hypoglycemia, 66.8% were treated and released, 25.1% were admitted to the hospital,
`and <0.1% died.
`Of the ED visits involving hyperglycemic crisis, 8.4% were treated and released, 84.4% were admitted to the hospital,
`and <0.1% died.
`Hospitalizations
`In 2020, a total of 7.86 million hospital discharges were reported with diabetes as any listed diagnosis among US adults
`aged 18 years or older (335.4 per 1,000 adults with diabetes) (Table 7). These discharges included:
`
`1.68 million for major cardiovascular diseases (71.6 per 1,000 adults with diabetes), including:
`368,000 for ischemic heart disease (15.7 per 1,000 adults with diabetes).
`321,000 for stroke (13.7 per 1,000 adults with diabetes).
`160,000 for a lower-extremity amputation (6.8 per 1,000 adults with diabetes).
`232,000 for hyperglycemic crisis (9.9 per 1,000 adults with diabetes).
`51,000 for hypoglycemia (2.2 per 1,000 adults with diabetes).
`
`Table 7. Number and rate of hospitalizations per 1,000 adults aged 18 years or older with diabetes for selected causes,
`United States, 2019 and 2020
`
`Risk factor
`
`Diabetes as any listed
`diagnosis
`
`2019
`Number
`
`2019 Crude rate per
`1,000 (95% CI)
`
`2020
`Number
`
`2020 Crude Rate per
`1,000 (95% CI)
`
`8,341,000
`
`356.1 (337.0–375.3)
`
`7,856,000
`
`335.4 (316.5–354.4)
`
`Major cardiovascular disease
`
`1,920,000
`
`82.0 (77.4–86.5)
`
`1,677,000
`
`71.6 (67.4–75.8)
`
`Ischemic heart disease
`
`443,000
`
`18.9 (17.8–20.0)
`
`368,000
`
`15.7 (14.7–16.7)
`
`Stoke
`
`346,000
`
`14.8 (13.9–15.6)
`
`321,000
`
`13.7 (12.9–14.5)
`
`Lower-extremity amputation
`
`162,000
`
`6.9 (6.5–7.3)
`
`160,000
`
`6.8 (6.4–7.2)
`
`Hyperglycemic crisis
`
`231,000
`
`9.9 (9.3–10.4)
`
`232,000
`
`9.9 (9.3–10.5)
`
`Diabetic ketoacidosis
`
`205,000
`
`8.8 (8.3–9.2)
`
`206,000
`
`8.8 (8.3–9.3)
`
`MPI EXHIBIT 1115 PAGE 13
`
`

`

`Risk factor
`
`2019
`Number
`
`2019 Crude rate per
`1,000 (95% CI)
`
`2020
`Number
`
`2020 Crude Rate per
`1,000 (95% CI)
`
`Hyperosmolar hyperglycemic
`syndrome
`
`26,000
`
`1.1 (1.0–1.2)
`
`26,000
`
`1.1 (1.1–1.2)
`
`Hypoglycemia
`
`60,000
`
`2.5 (2.4–2.7)
`
`51,000
`
`2.2 (2.1–2.3)
`
`Notes: CI = confidence interval. Numbers rounded to the nearest thousand. Data sources: 2019 and 2020 National Inpatient Sample; 2019 and 2020
`National Health Interview Survey.
`
`Kidney Disease (See Appendix B: Detailed Methods)
`Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2017–2020 shown in Appendix Table
`11 indicated:
`
`39.2% had chronic kidney disease (CKD, stages 1–4), based on the updated 2021 CKD Epidemiology Collaboration
`(CKD-EPI) equation for estimated glomerular filtration rate (eGFR).
`15.7% had moderate to severe CKD (stage 3 or 4).
`23.1% of non-Hispanic Black adults, 17.2% of non-Hispanic White adults, and 8.9% of Hispanic adults had
`moderate to severe CKD (stage 3 or 4).
`32.5% with moderate to severe CKD (stage 3 or 4) were aware of their kidney disease.
`40.9% had chronic kidney disease (CKD, stages 1–4), based on the 2009 CKD-EPI eGFR equation, which included a
`factor for Black race.
`
`In 2019:
`
`A total of 61,522 people developed end-stage kidney disease with diabetes as the primary cause.
`Crude incidence of end-stage kidney disease with diabetes as the primary cause was 192.7 per 1 million population
`(61,522 new cases). Adjusted for age group, sex, and racial or ethnic group, the rate was 179.5 per 1 million people.
`The proportion of end-stage kidney disease with diabetes listed as the primary cause was 39.2% (307,385 out of
`783,594 people). As a result, diabetes was the leading cause of end-stage kidney disease, followed by high blood
`pressure (26.7%), glomerulonephritis (14.6%), and cystic kidney disease (5.0%).
`Vision Disability (See Appendix B: Detailed Methods)
`Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years.
`Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2021 indicated:
`10.1% (95% CI, 9.6%–11.3%) reported severe vision difficulty or blindness.
`Deaths
`In 2021, diabetes was the eighth leading cause of death in the United States. This finding is based on 103,294 death
`certificates in which diabetes was listed as the underlying cause of death (crude rate, 31.1 per 100,000 people).
`In 2021, there were 399,401 death certificates with diabetes listed as the underlying or contributing cause of death
`(crude rate, 120.3 per 100,000 people).
`Costs
`The total direct and indirect estimated costs* of diagnosed diabetes in the United States in 2022 was $413 billion.
`Total direct estimated costs of diagnosed diabetes increased from $227 billion in 2012 to $307 billion in 2022 (2022
`dollars). Total indirect costs increased from $89 billion to $106 billion in the same period (2022 dollars).
`From 2012 to 2022, excess medical costs per person associated with diabetes increased from $10,179 to $12,022
`(2022 dollars).
`
`5
`
`6
`
`* Direct costs = medical costs; indirect costs = lost productivity from work-related absenteeism, reduced productivity at
`work and at home, unemployment from chronic disability, and premature mortality
`
`MPI EXHIBIT 1115 PAGE 14
`
`

`

`References and Citation
`
`
`
`1. Wagenknecht LE, Lawrence JM, Isom S, et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the
`USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol.
`2023;11(4):242–250. doi: 10.1016/S2213-8587(23)00025-6
`2. Su X, Kong Y, Peng D. Evidence for changing lipid management strategy to focus on non-high density lipoprotein
`cholesterol. Lipids Health Dis. 2019;18(1):134.
`3. American Diabetes Association. Standards of medical care in diabetes—2023. Diabetes Care. 2023;46 (suppl 1).
`4. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for the
`management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23(suppl 2).
`5. Centers for Disease Control and Prevention. CDC WONDER. About Underlying Cause of Death 1999–2020. Accessed
`April 25, 2023. http://wonder.cdc.gov/ucd-icd10.html
`6. Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, ElSayed NA, Bannuru RR. Economic Costs of Diabetes in the
`U.S. in 2022. Diabetes Care. 2023 Nov 1:dci230085. doi: 10.2337/dci23-0085. Online ahead of print.
`
`Suggested Citation
`
`Centers for Disease Control and Prevention. National Diabetes Statistics Report website.
`https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed [date].
`
`Last Reviewed: November 29, 2023
`
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`MPI EXHIBIT 1115 PAGE 15
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`