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
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
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
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 Education and Support in
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