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Rural Health Information Hub

Why Diabetes is a Concern for Rural Communities

According to the Centers for Disease Control and Prevention's National Diabetes Statistics Report, as of 2018 an estimated 26.9 million people (8.2% of the population) had diagnosed diabetes in the United States. In 2016, 12.6% of the population had diagnosed diabetes in nonmetropolitan counties, compared to 9.9% in metropolitan counties. In one region of the U.S., referred to as the “diabetes belt,” the prevalence of diabetes is approximately 11.7% of the population. The diabetes belt spans over 644 counties in 15 states. More than one-third of the counties in the diabetes belt are within the Appalachian Region, and most states in the diabetes belt are more rural than the U.S. average.

Diabetes is an increased concern for rural communities compared to urban communities because of risk factors that are prevalent in rural communities and access to a variety of services.

Risk Factors

There are many risk factors associated with diabetes. Having one or more risk factors increases the likelihood of developing diabetes. Common risk factors for diabetes include:

  • Overweight and obesity
  • Physical inactivity
  • Poor diet
  • Older age (age 45 and older)
  • Family history of having diabetes
  • Race and ethnicity

Rural areas have higher rates of obesity, putting them at an increased likelihood of developing diabetes. Some of the rural community characteristics that contribute to this risk include environmental characteristics and access barriers, which can make it more challenging to consume healthy foods, such as fruits and vegetables.

Rural communities often have populations that are at an increased risk of developing type 2 diabetes, including older adults and certain racial and ethnic groups. Some racial and ethnic groups at higher risk of diabetes include people of Alaska Native, American Indian, African American, Hispanic, and Asian or Pacific Islander descent.


Some of the barriers to accessing healthcare and health education in rural communities include:

  • Fewer healthcare providers – Workforce shortages make it difficult to provide diabetes education, retain dietitians and nutritionists, and replace retiring providers. It also limits access to specialty care providers, such as endocrinologists.
  • Higher rates of uninsured – Inadequate access to health insurance makes it more challenging for rural populations to cover medical appointments, medications, and supplies.
  • Fewer transportation options – Limited access to transportation options in rural areas makes it more difficult for people with diabetes to travel to appointments.

For more information on the key issues affecting healthcare access among rural populations, see the Healthcare Access in Rural Communities topic guide.

Resources to Learn More

Diabetes Self-Management in Rural America as a Public Health Issue
Describes the diabetes self-management education (DSME) program, with a focus on rural communities, giving patients the knowledge and skills needed to manage their diabetes and improve health. Provides information about the National Diabetes Education Program (NDEP) offering culturally and linguistically appropriate diabetes education resources, and includes diabetes prevention and management resources for rural communities.
Organization(s): Centers for Disease Control and Prevention