SAT-645 - State-Level, Age, Sex, and Risk Factor Disparities in the Burden of Type 2 Diabetes Mellitus in the United States: A Global Burden of Disease 2023 Analysis

Background
Type 2 diabetes mellitus (T2DM) remains a major public health challenge in the United States, with substantial geographic, demographic, and risk factor–driven heterogeneity. A contemporary state-level assessment is essential to characterize disease burden and temporal trends.
Methods
Age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASDR), and disability-adjusted life-year (DALY) rates per 100,000 population were extracted from the Institute for Health Metrics and Evaluation Global Burden of Disease (GBD) 2023 study using the IHME Results Tool. Analyses included all 50 U.S. states and the District of Columbia. State-level variation, age- and sex-specific patterns, and risk factor attribution were examined. Temporal trends were assessed using estimated annual percent change (EAPC) with 95% confidence intervals (CI).
Results
Marked interstate variation in T2DM burden was observed. Incidence rates were highest in West Virginia (446.34), Alabama (426.95), and Delaware (425.50), and lowest in Colorado (256.09), Montana (281.27), and Wyoming (285.70). Prevalence was highest in Alabama (9191.99), West Virginia (9025.02), and Kentucky (8668.79), and lowest in Colorado (5018.29), Montana (5384.24), and Wyoming (6609.35). Mortality rates were highest in West Virginia (20.70), Arkansas (18.22), and Louisiana (16.97), and lowest in Hawaii (7.94), Connecticut (8.54), and Colorado (8.61). DALY rates were highest in West Virginia (1145.73), Alabama (1042.99), and Kentucky (1021.43).
Age-specific analyses demonstrated that prevalence peaked at ages 75–79 years, while mortality and DALY rates were highest among individuals aged ≥80 years, with a consistently higher burden in males. High fasting plasma glucose accounted for the largest proportion of DALYs across all states, followed by high body-mass index. From 1990 to 2023, ASIR and ASPR increased significantly (ASIR EAPC 1.52%, 95% CI 1.49–1.56; ASPR EAPC 1.51%, 95% CI 1.46–1.55), while mortality declined (ASDR EAPC −1.24%, 95% CI −1.63 to −0.84). DALY rates showed a modest increase (EAPC 0.39%, 95% CI 0.25–0.54).
Conclusion
Type 2 diabetes mellitus burden in the United States exhibits profound geographic and demographic inequities, driven predominantly by metabolic risk factors. Despite declining mortality, continued increases in incidence, prevalence, and DALYs indicate a growing population-level disease burden. These findings highlight an urgent need for state-specific public health policies prioritizing obesity prevention, glycemic control, and lifestyle interventions, particularly in high-burden states and aging populations, to curb long-term morbidity and health system strain.

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