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November 2024

Diabetes in North Dakota: Differences, Similarities, and Prevalence

Kaeleigh Schroeder, MA, MSc, is a research specialist at the Center for Social Research, working on survey research projects and ND Compass. She has over a decade of research experience, starting in market research after receiving her Master’s degree in Sociology at the University of Manitoba. With experience in health care, publishing, and non-profit sectors, Schroeder has worked with a variety of research and data, and enjoys analysis of all kinds. Her most recent degree, a Master of Science in Business Analytics from North Dakota State University, is helpful as she contributes to new ND Compass data visualizations.

Introduction

November is National Diabetes Awareness Month in the United States. Diabetes is a chronic condition that impacts nearly 40 million people of all ages with over a million new cases being diagnosed each year in the United States (Centers for Disease Control and Prevention (CDC), 2024). Sharing information and increasing diabetes awareness is essential, as it can help people recognize risk factors, encourage early detection, and inspire lifestyle modifications that could help prevent or delay the start of diabetes.

Three of the most prevalent types of diabetes are type 1, type 2 and gestational diabetes. Although all are diabetes, each type of diabetes is caused by a different issue in the body and must be uniquely treated. As well, with the recent developments in type 2 diabetes management with a new injectable treatment, understanding more about diabetes can be an important part of health. Understanding the impacts and health management of this incurable condition is important, especially as we age; for instance, older adults are at a higher risk of developing type 2 diabetes compared to younger people, and some women are also more at risk of developing gestational diabetes while pregnant.

Type 1 diabetes

Type 1 diabetes is diagnosed in those whose pancreas does not make insulin at all, or makes very little insulin. Insulin is what the body uses to process blood sugar, and without insulin, blood sugar builds up in the bloodstream, causing complications (Centers for Disease Control and Prevention (CDC), 2024). Type 1 diabetes can be difficult to diagnose since symptoms look similar to many different health conditions, but it is usually diagnosed in children, teens, or young adults. It is much less common than type 2 diabetes, however – about 4 in every 1,000 youths (persons aged less than 18 years) and 5 in every 1,000 adults (persons aged 18 and older) has type 1 diabetes (Fang, Wang, & Selvin, 2024). Although the prevalence of type 1 diabetes appears to be growing, improvements in insulin and blood sugar management for diabetes have helped people with diabetes live longer and manage the condition more effectively.

Type 2 diabetes

Type 2 diabetes is much more common, and it is caused by a failure of the body to properly use the insulin it produces. This type of diabetes accounts for between 90-95% of all diabetes cases in the United States, and it can develop at any age. There are many risk factors – some are health-related, such as low physical activity and high weight levels, and some are personal, such as being age 45 or older or having a family history of diabetes – but this type of diabetes can often be effectively managed through lifestyle changes such as eating healthier and becoming more active (Centers for Disease Control and Prevention (CDC), 2024).

Gestational diabetes

Gestational diabetes is specific to pregnant women who did not have diabetes prior to pregnancy and occurs when the body can’t make enough insulin during pregnancy (Centers for Disease Control and Prevention (CDC), 2024). Physiological changes during pregnancy, such as weight or hormone fluctuations, can impact the body in a variety of ways, including insulin resistance – when the body uses insulin less effectively, and needs more of it to do the same job. Pregnant people are commonly tested for gestational diabetes just over halfway through their pregnancy, around the 24th to 28th week, unless they are at a higher risk. Gestational diabetes impacts between five to nine percent of all pregnant women in the United States, annually (Centers for Disease Control and Prevention (CDC), 2024). Although gestational diabetes in pregnant women typically goes away after the delivery, one in two women who develop gestational diabetes will go on to be diagnosed with type 2 diabetes later in life (Centers for Disease Control and Prevention (CDC), 2024). Many things used to effectively manage type 2 and gestational diabetes are also beneficial to a healthy pregnancy, so focusing on eating a healthy diet, weight management, and physical activity during pregnancy may help manage or prevent gestational diabetes.

Undiagnosed diabetes

The Centers for Disease Control and Prevention (CDC) estimates that nearly nine million American adults have undiagnosed diabetes. This estimate, combined with the 29.4 million diagnosed American adults, equates to a projection of 38.1 million total adult Americans living with diabetes in 2021. This is approximately 13% of the adult population, or more than one in ten Americans that has diabetes, which is a gradual increase from 2001 (Figure 1).

Figure 1: Trends in Age-Adjusted Prevalence of Diagnosed and Undiagnosed Diabetes among Adults Age 18 Years and Older, United States, 2001 to 2020 (percentage)

Data from the Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report, Appendix A: Detailed Tables. May 2024.

Undiagnosed diabetes was assessed using laboratory criteria for diabetes (fasting plasma glucose and A1C levels among people who self-reported not having diabetes). This was also the method for assessing prediabetes, a condition that precedes a type 2 diagnosis. While 38% of adults in the United States were considered to have prediabetes in 2021, only 19% reported they were informed by a health professional about their diagnosis (Centers for Disease Control and Prevention (CDC), 2024).

Persistent levels of undiagnosed diabetes and prediabetes points to a greater challenge for Americans in taking steps to manage these conditions before they become seriously damaging and irreversible. Without proper awareness and accommodation, diabetes can cause a number of complications, especially for those with pre-existing conditions. The CDC reports that in 2021, diabetes was the eighth leading cause of death in the United States; more than one hundred thousand deaths were directly caused by diabetes, and the condition contributed to nearly four hundred thousand additional deaths as an underlying cause (Centers for Disease Control and Prevention (CDC), 2024).

Diabetes in North Dakota

North Dakota compared to the nation

Prevalence of diabetes among adults in the United States has been trending up since 2011; this includes both type 1 and type 2 diabetes (1). In 2023, the nationwide prevalence of adults with diabetes was 12%, while the rate in North Dakota was 10%. North Dakota had one of the lowest rates of diabetes in the nation that year (ranking sixth lowest in the U.S.); West Virginia had the highest prevalence of diabetes, with 18.2%, and many southern states had prevalence rates at or over 15%.

Diabetes by demographics

North Dakota’s senior population has the highest rates of diabetes among age groups; those age 65 years and older consistently retain the highest rates of diabetes nationwide. In 2022, nearly 20% of North Dakotans age 65 years and older were living with diabetes; however, this is an improvement on 2018, when that rate was highest, at 22% (Figure 2).

Figure 2: Diabetes Prevalence by Age Group, North Dakota, 2011 to 2022 (percentage)

Data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS), October 2024.

Diabetes prevalence also differed by income. In 2022, 19% of North Dakotans with income less than $15,000 had diabetes; this rate has climbed steadily from 2016 (Figure 3).

Figure 3: Adult Diabetes Prevalence by Income Grouping, North Dakota, 2011 to 2022 (percentage)

Data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS), October 2024.

Statewide trends mirror national trends when it comes to the prevalence of diabetes examined by racial background. Among American Indian and Alaska Native (AIAN) North Dakota adults, 19% had diagnosed diabetes in 2022, while 10% of white, non-Hispanic North Dakota adults had diabetes in the same year. The rate of diabetes among AIAN North Dakotans continues to trend higher than the white, non-Hispanic counterparts (Figure 4).

Figure 4: Adult Diabetes Prevalence by Race and Ethnicity, North Dakota, 2011 to 2022 (percentage)

Data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS), October 2024.

There are generally no significant differences in diabetes rates by gender in North Dakota; both adult males and females have similar prevalence over time. Nationwide, more males than females have type 2 diabetes; in 2022, 16% of men and 13% of women in the United States had diagnosed diabetes, while 4% of men and 5% of women had undiagnosed diabetes (Centers for Disease Control and Prevention (CDC), 2024). Some research reports that men are usually diagnosed younger and at a lower body fat mass than women, but due to health changes such as pregnancy and menopause, women are often at higher risk for developing type 2 diabetes, and less likely to receive the treatment for cardiovascular disease risk factors than men (Kautzky-Willer, Leutner, & Harreiter, 2023).

Gestational diabetes

According to the North Dakota Pregnancy Risk Assessment Monitoring System (PRAMS), gestational diabetes affected 11% of pregnant women in North Dakota in 2020, with significantly higher rates among women 40 years and older, and those who were overweight or obese prior to their pregnancy (2)(Figure 5). The percentage of pregnant women impacted by the condition showed an upward trend since 2017 in the state (7% in 2017).

Figure 5: Prevalence of Gestational Diabetes, North Dakota, 2017 to 2020 (percentage)

Data from the Centers for Disease Control (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS), December 2022.

Gestational diabetes impacted a variety of pregnancy and birth outcomes, such as the presence of preeclampsia or eclampsia (a high blood pressure condition related specifically to pregnancy), and the baby’s length of stay in the hospital after birth. In North Dakota, nearly one in four women with gestational diabetes had high blood pressure that started during their pregnancy (22% compared to just 10% among those without gestational diabetes) (Center for Social Research at NDSU, 2022). Babies born to women without gestational diabetes were more likely to stay in the hospital less than three days compared to those babies born to those with gestational diabetes (71% compared to 61% of babies, respectively) (Center for Social Research at NDSU, 2022). For more information on gestational diabetes in North Dakota, see the PRAMS Points dashboard in ND Compass Trends: Data Visualizations.

Managing Diabetes

Advancements in healthcare have improved diabetes management for people with type 1 and type 2 diabetes; insulin pumps and ports have assisted people with type 1 diabetes in administering insulin in a timely manner, and not relying on outmoded blood testing methods to avoid dangerous blood sugar spikes or drops. As well, recent drug advancements now allow people with type 2 diabetes to receive various drugs that assist with blood sugar regulation, including injections and pills. Some of the drugs that help manage type 2 diabetes are also known for weight reduction as a side effect (such as semaglutide medications like Ozempic); medical advice notes that these drugs should be used in conjunction with life changes consistent with helping manage type 2 diabetes – while they assist in managing the condition, they are not a “cure.”

Gestational diabetes does not commonly have drugs associated with its management, though health care providers may prescribe insulin. The most common treatments are diet management, exercise, and safe weight loss (generally recommended outside of pregnancy, not during pregnancy).

Conclusion

As medical professionals continue to research the impact of comorbidities (that is, having multiple health conditions at the same time) in the wake of the COVID-19 pandemic, discussions around access to healthy food, sedentary versus active time, and understanding your own health have never been more relevant. While type 1 diabetes causes are still unclear, it is possible to manage some risk factors for type 2 diabetes. It is also important to understand the links between diabetes risk and demographic factors like age and income. Some options available for managing the condition, or mitigating risk factors, are dependent on privileges not accessible to all people, but working with a health care professional can provide assistance or choices.

Notes

(1) Data are from the Behavioral Risk Factor Surveillance System (BRFSS) survey; respondents were asked, “Have you ever been told by a doctor that you have diabetes?” and no differentiation was made between types 1 and 2. This data does not include gestational diabetes.

(2) Body Mass Index (BMI) is used in the PRAMS survey to determine respondent weight category: underweight, normal, overweight, or obese.

References

Center for Social Research at NDSU. (2022, April). PRAMS Points: Gestational Diabetes. Retrieved October 28, 2024, from North Dakota Compass: https://www.ndcompass.org/trends/Visualizations/Data_visualizations4.php
Centers for Disease Control and Prevention (CDC). (2024, May 15). About Gestational Diabetes. Retrieved October 4, 2024, from Diabetes: https://www.cdc.gov/diabetes/about/gestational-diabetes.html
Centers for Disease Control and Prevention (CDC). (2024, May 15). About Type 1 Diabetes. Retrieved October 4, 2024, from Diabetes: https://www.cdc.gov/diabetes/about/about-type-1-diabetes.html
Centers for Disease Control and Prevention (CDC). (2024, May 15). About Type 2 Diabetes. Retrieved October 4, 2024, from Diabetes: https://www.cdc.gov/diabetes/about/about-type-2-diabetes.html
Centers for Disease Control and Prevention (CDC). (2024, May 15). National Diabetes Statistics Report. Retrieved October 22, 2024, from Diabetes: https://www.cdc.gov/diabetes/php/data-research/index.html
Fang, M., Wang, D., & Selvin, E. (2024). Prevalence of Type 1 Diabetes Among US Children and Adults by Age, Sex, Race, and Ethnicity. JAMA, 1411-1413. Retrieved October 10, 2024, from https://jamanetwork.com/journals/jama/fullarticle/2816774
Kautzky-Willer, A., Leutner, M., & Harreiter, J. (2023). Sex differences in type 2 diabetes. Diabetologia, 986-1002. Retrieved October 10, 2024, from https://pubmed.ncbi.nlm.nih.gov/36897358/