Type 2 diabetes, the most common form of diabetes, affects millions of people nationwide. The disease develops when the body either resists insulin or fails to produce enough insulin, resulting in elevated blood sugar levels. In this post, I discuss the prevalence of Type 2 Diabetes across North Carolina’s 100 counties and its association with county-level contextual factors.
The map below shows 2021 diabetes rates across the United States, showing that about 6–12% of most counties’ population is affected by the disease. The prevalence of diabetes is significant as research indicates higher rates of diabetes in counties with limited healthcare access, lower educational attainment, and lower median incomes. Over time, unmanaged high blood sugar can lead to other serious health complications, including heart disease, kidney failure, and vision loss.
According to the Centers for Disease Control and Prevention (CDC), In 2021, 15.8% of NC adults were diagnosed with diabetes.
The counties reporting the highest prevalence of diabetes are Sampson County (13.5%), Robeson County (13.1%), and Scotland County (12.4%).
Why do we observe such drastic variation in diabetes rates across counties? Disparities in health outcomes are often explained by focusing exclusively on individual health behaviors and access to care. Although those are important, further upstream factors, referred to collectively as the social determinants of health, also play an important role. For example,
Sampson County, with the highest diabetes rate in North Carolina at 13.5%, provides a clear example of how social determinants of health can influence disease prevalence. It is unclear which specific factor is directly causing increased diabetes rates, but a combination of these influences is driving the high prevalence. For example, it is well-documented that educational attainment is related to health and longevity. That is, people with more educational attainment, in general, have better outcomes and live longer. Similarly, income and poverty are related to health outcomes such as diabetes. Finally, racial discrimination is also linked with poorer health and shorter lives for racial minorities.
While upstream social determinants of health shape the broader conditions that influence disease prevalence, they are related to downstream factors that more directly impact individual health outcomes. In Sampson, Robeson, and Scotland counties, key downstream factors such as obesity prevalence and high uninsured rates may contribute to the elevated diabetes burden.
Obesity, a major risk factor for type 2 diabetes, is notably high in these counties. Although Sampson County’s obesity rate aligns with the state average, Robeson and Scotland counties far exceed it, further compounding diabetes risks. Excess body weight is strongly linked to insulin resistance and the development of diabetes, making higher obesity rates a direct driver of the condition’s prevalence.
Additionally, limited access to healthcare exacerbates diabetes risks. In Sampson County, 24.8% of adults are uninsured, compared to 22.3% in Robeson County and 20.0% in Scotland County. Lacking health insurance restricts access to regular check-ups, preventive screenings, and early interventions. Without these services, individuals are more likely to have unmanaged or undiagnosed diabetes, increasing the risk of severe complications over time. The financial burden of managing chronic conditions without insurance also deters individuals from seeking care, as out-of-pocket costs for medications, supplies, and treatments become prohibitive.
These downstream factors, including obesity and inadequate access to healthcare, are associated with higher diabetes rates and poorer health outcomes in these North Carolina counties.
Across North Carolina, the relationship between high rates of diabetes and upstream social determinants of health, such as low education levels and poverty, highlights the structural inequities in chronic disease. Targeting high-risk areas and expanding comprehensive approaches and preventative efforts that address educational attainment, family sustaining wages, fresh food access, and affordable healthcare access along with promoting individual health behaviors related to diet, exercise, and smoking, can help reduce prevalence. Success depends on sustained support, data-driven resource allocation, and ongoing monitoring.
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Tags: Diabetes, health, North Carolina
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