Diabetes mortality rates in the United States have shown significant fluctuations over the past two decades. From 2000 to 2019, the overall age-standardized diabetes mortality rate decreased by 32.1%, dropping from 28.1 deaths per 100,000 to 19.1 deaths per 100,0001. This decline was observed across all racial and ethnic populations, with the American Indian or Alaska Native population experiencing the largest absolute reduction (27.9 deaths per 100,000), followed by the Black population (24.1 per 100,000) and the Latino population (19.8 per 100,000)1.

Despite these improvements, substantial disparities persist. In 2019, national-level rates were highest among American Indian or Alaska Native populations (35.6 per 100,000), followed by Black (31.9), Latino (19.7), White (17.6), and Asian (12.6) populations12. After years of decline, concerning trends emerged for several diabetes-related complications, with hospitalization rates increasing for heart failure (2012-2020), stroke (2009-2020), and lower-extremity amputations (2009-2020)3. By 2022, diabetes had become the eighth leading cause of death in the United States, with 101,209 deaths (30.4 per 100,000 population) attributed directly to the condition45.

The COVID-19 pandemic significantly worsened diabetes mortality rates, reversing years of steady decline. During 2021, diabetes rose to become the eighth leading cause of death in the United States, resulting in more than 103,000 deaths1. People with diabetes faced substantially higher risks when contracting COVID-19, with studies showing they were 1.59-1.78 times more likely to die from COVID-19 than non-diabetic patients2. This increased vulnerability stemmed from multiple factors:

• Diabetes creates a hyperglycemic environment that facilitates SARS-CoV-2 proliferation3

• Pandemic-related disruptions to routine diabetes care, physical activity, and medical services45

• Diabetes patients were 2-4 times more likely to develop severe COVID-196

• Type 1 diabetes patients had 3.5 times higher odds of COVID-19-related in-hospital death, while type 2 diabetes patients had 2.03 times higher odds7

• Approximately 21.4% of individuals hospitalized with COVID-19 had diabetes, rising to 34.6% among those who died from COVID-193

Significant racial and ethnic disparities persist in diabetes mortality across the United States. American Indian and Alaska Native populations face the highest diabetes mortality rates (35.6 per 100,000), followed by Black Americans (31.9 per 100,000), Latino Americans (19.7 per 100,000), White Americans (17.6 per 100,000), and Asian Americans (12.6 per 100,000)12. These disparities reflect broader systemic inequities, with Black Americans being twice as likely to die from diabetes compared to White Americans in large U.S. cities3.

While mortality gaps have narrowed somewhat over time, geographic variations remain pronounced. The highest mortality rates for Native Americans are concentrated in central Mississippi, southwestern Oklahoma, and eastern South Dakota, while Black Americans face the highest rates in the Mississippi Delta region2. Contributing factors to these disparities include systemic racism, limited access to healthcare, socioeconomic challenges, and differences in diabetes self-management knowledge34. Despite these challenges, targeted interventions have shown promise-kidney failure rates among Native Americans with diabetes dropped by 54% between 1996 and 2013 following comprehensive IHS diabetes programs5.