The National DPP → Evidence
Evidence
Research studies and evaluations have repeatedly shown that interventions such as the National DPP lifestyle change program improve health outcomes and are cost-effective or cost-saving. Evidence supporting these outcomes can be found below. For more information or to suggest additional content, please email coveragetoolkit@chronicdisease.org.
This page is organized under the following headings:
Program Outcomes
Includes: Original and Translational Research Studies | Diabetes Prevention Programs | Medicare DPP | Medicaid | Employers | Specific Populations
Program Outcomes | Original & Translational Research Studies
The Diabetes Prevention Program (DPP) (2002)
The Diabetes Prevention Program (DPP) was a randomized clinical trial funded by the National Institutes of Health (NIH) and supported by the CDC, launched in 1996. Among the 1,079 participants who received the lifestyle intervention (rather than the metformin or placebo intervention), the incidence of type 2 diabetes was reduced by 58%. The intervention targeted a 7% reduction in body weight and at least 150 minutes of physical activity per week. It included individual coaching, a 16-session core curriculum, supervised physical activity, and additional program supports.
Diabetes Prevention Program Outcomes Study:
Long-term follow-up studies at 10 and 15 years further demonstrated sustained impact. At 15 years, diabetes incidence remained 27% lower among participants who received the intervention. Cumulative diabetes incidence was 55% in the intervention group, compared to 62% among those who did not receive the intervention.
An analysis of DPP data conducted in 2009 found that, compared with the placebo intervention, the cost per quality-adjusted life-years (QALY) was approximately $1,100 for the lifestyle intervention and $31,300 for the metformin intervention. Researchers concluded that the DPP lifestyle intervention was highly cost-effective across age ranges and cost-saving in participants younger than 45.
Translating the Diabetes Prevention Program into the Community: The DEPLOY Pilot Study (2008)
The DEPLOY Pilot Study examined the feasibility of offering the DPP clinical trial intervention in community settings, using a lower-cost group-based model. Trained YMCA wellness instructors facilitated the group sessions. Participants lost an average of 6% of their body weight.
Program Outcomes | Diabetes Prevention Programs (General)
Public Health Approaches to Type 2 Diabetes Prevention: The U.S. National Diabetes Prevention Program and Beyond (2019)
This CDC-led review examines the foundational evidence, translation studies, and current research behind type 2 diabetes prevention efforts worldwide. Findings underscored the critical importance of lifestyle change programs, targeting those at highest risk through both in-person and virtual models of program delivery, whole-population approaches (e.g., socioeconomic policies, healthy food promotion, and environmental/systems changes), and building awareness.
Analysis of Diabetes Prevention Recognition Program (DPRP) data (2012 – 2019) found that for participants who completed at least three sessions, about 40% attended at least seventeen sessions, 31% met the minimum weight loss goal, and 45% met the weekly goal of averaging 150+ minutes per week of physical activity. Weight loss was significantly higher among those who attended 17 sessions or more, those who stayed in the program for nine or more months, and those meeting the weekly physical activity goal.
Additional CDC-Led Analyses of DPRP Data:
Delivering the National DPP: Assessment of Enrollment in In-Person and Virtual Organizations (2022): Analyzed the cumulative enrollment and characteristics of eligible participants in the National DPP lifestyle change program by delivery mode.
Enrollment Characteristics and Results for Adults Aged 18-44 in the National DPP (2022): Examined the characteristics of individuals aged 18-44 who enroll in the National DPP lifestyle change program, as well as some of the outcomes associated with this subgroup of participants. Results highlight the opportunity to develop strategies focused on supporting younger adults to enroll in and complete the National DPP lifestyle change program.
Effect of Organization Type on Priority Population Outcomes in the National DPP (2022): Examined the impact of CDC-recognized organization type on program participation and participant risk reduction. Results indicate that certain types of organizations might better serve populations at highest risk for type 2 diabetes.
Impact of Participant Characteristics on Weight Loss in the National DPP, 2012 - 2021 (2022): Assessed the association between participant characteristics and achieving 5% weight loss. Results indicated that program delivery strategies tailored to specific populations could be effective in helping participants achieve program goals.
A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC's National DPP (2017): Found that participants attended a median of 14 sessions, 35.5% of participants achieved the 5% weight loss goal, and 41.8% met the physical activity goal of 150 minutes per week. For every additional session attended and every 30 minutes of activity reported, participants lost 0.3% of body weight.
Using a RE-AIM Framework to Identify Promising Practices in National DPP Implementation (2019)
In 2012, the CDC funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change program. This study describes the reach, adoption, and maintenance of the program during the 4-year funding period and assesses associations between site-level factors and program effectiveness regarding participant attendance and participation duration. The study highlights strategies such as using self-referral or word of mouth as a referral strategy, promoting health care provider referrals, providing non-monetary incentives for participation, and using cultural adaptations to address participant needs.
Long-Term Sustainability of Diabetes Prevention Approaches (2017)
In this meta-analysis of randomized clinical trials including over 49,000 participants, lifestyle modification and medications promoting weight loss or insulin sensitization showed a 36-39% reduction in diabetes risks. Effects of medications were not sustained after they were discontinued; the effects of lifestyle modification, however, were sustained after the intervention was stopped, although the effects waned over time.
Report: Long-Term Effects of Diabetes Prevention Programs (2017)
This report from the Center for Evidence-Based Policy at Oregon Health & Science University reviews the long-term health effects of dietary and physical activity interventions among individuals at high risk for type 2 diabetes. Key findings included:
- Across all studies, with up to 23 years of follow up (10 years for U.S. studies), participants in a combined diet and physical activity promotion program demonstrated a reduction of nearly 50% in the risk of diabetes.
- More intense programs (such as those including more sessions, targets for weight loss, diet, or physical activity, and a maintenance period) demonstrated greater reduction for diabetes risk, lower A1c levels, and weight loss.
A Systematic Review of Real-World Diabetes Prevention Programs: Learnings from the Last 15 Years (2015)
This systematic review included thirty-eight studies and focused on identifying the critical success factors for implementing diabetes prevention programs in real-world settings. Researchers found that program intensity plays a major role in weight loss outcomes. However, those that have high uptake but are delivered at a lower intensity still may have a considerable impact in lowering diabetes risk in a population.
Can Diabetes Prevention Programs be Translated Effectively into Real-World Settings and Still Deliver Improved Outcomes? A Synthesis of Evidence (2012)
A review of 17 translational studies that implemented either the U.S. National DPP lifestyle change program or the Finnish Diabetes Prevention Study found that weight loss occurred for intervention participants in all but one study. The review concluded that “there is potential for less intensive interventions both to be feasible and to have an impact on future progression to diabetes in at-risk individuals.”
Program Outcomes | Medicare Diabetes Prevention Program (MDPP)
Evaluation of the Medicare Diabetes Prevention Program (2025)
The Centers for Medicare and Medicaid Services (CMS) MDPP Final Evaluation Report summarizes findings related to MDPP supplier enrollment, beneficiary engagement and participation, short-term health outcomes, and long-term health outcomes. Some study highlights include:
- More than half of participants achieved 5% weight loss, and one-quarter achieved 9 percent weight loss; average weight loss was 4.9%. In addition to weight loss, participants reported improved nutrition, increased physical activity, and improved health-related outcomes such as reductions in A1C.
- On average, participants attended 18 out of 22 possible sessions.
- Two-thirds of MDPP suppliers were health care organizations, 19% were community-based organizations, 8% were state or local health departments, and 7% were YMCAs.
Translating Knowledge into Action to Prevent Type 2 Diabetes: Medicare Expansion of the National DPP Lifestyle Intervention (2020)
In this study, researchers used the Knowledge to Action framework (K2A) to understand how the National DPP lifestyle change program was translated from research into a Medicare covered benefit. The researchers identified and described four key milestones: strong evidence base, cross-sector engagement to create a national infrastructure, evidence of effectiveness with the Medicare population, and extensive public input into the MDPP.
Impact of the YMCA of the USA Diabetes Prevention Program on Medicare Spending and Utilization (2017)*
This claims analysis tested whether the YMCA of the USA’s (Y-USA) implementation of the National DPP lifestyle change program with Medicare beneficiaries reduced medical spending and utilization. Researchers found average savings of $278 per member per quarter during the first three years when compared to a group of non-participants. The participant group also had nine fewer inpatient stays and nine fewer emergency department visits per 1,000 participants per quarter.
*Requires subscription or payment
CMS Office of the Actuary (OACT) Certification Report (2016)
In March 2016, the CMS Office of the Actuary (OACT) released a certification report for expansion of the Y-USA Diabetes Prevention Program (DPP). It reviewed results from the first two years of program implementation, the original DPP clinical trial, and a subset of lifestyle change programs recognized by the CDC. The report confirmed the results and certified that an expansion of the DPP in the Medicare population would reduce (or not increase) net-Medicare spending. This was the impetus for Medicare to establish coverage for the MDPP effective April 2018.
The Center for Medicare & Medicaid Innovation (CMMI) Health Care Innovation Awards – Y-USA Implementation (2015)
This evaluation report describes the outcomes of the Y-USA implementation of the National DPP lifestyle change program with Medicare beneficiaries. A cost analysis of the initiative found that in the first eight quarters of the program, health care savings amounted to $2,662 per participant when compared to Medicare beneficiaries who were eligible for the program but did not participate. Through the first 11 quarters, those attending at least one core session lost 3.8% of their body weight, and those attending at least four core sessions lost 4.5% of their body weight.
Program Outcomes | Medicaid
Medicaid Coverage for the National DPP Demonstration Project (2018)
The Medicaid Coverage for the National DPP Demonstration Project was a multi-year initiative in Maryland and Oregon designed to identify and address real-world challenges related to Medicaid coverage of the lifestyle change program. The evaluation showed that the program can be effectively implemented through Medicaid managed care, and that Medicaid beneficiaries can maintain participation in the program and achieve significant weight loss.
Lessons learned from the Demonstration Project informed the development of the Coverage Toolkit, and insights from the project are incorporated throughout, especially in the Medicaid section.
Information on the effects of financial incentives on program attendance and weight loss among Medicaid beneficiaries and CMMI’s Medicaid Incentives for the Prevention of Chronic Diseases program can be found in the Program Outcomes | Incentives & Program Supports section.
Research articles demonstrating the cost effectiveness of diabetes prevention programs in Medicaid populations can be found in the Cost Analysis | Medicaid section of this page.
Program Outcomes | Employers
Evaluation of a Digital Behavioral Counseling Program for Reducing Risk Factors for Chronic Disease in a Workforce (2017)
This matched comparison study evaluated more than 600 employees and their dependents who participated in an online diabetes prevention program, compared with over 1,200 matched nonparticipants. Prior to the program, employees were gaining an average of 3.5 pounds annually. After one year, participants showed improved outcomes compared with nonparticipants, including weight reduction (31% lost at least 5% of their starting weight), improved fasting blood glucose, and better nutritional intake.
Effect of Intensity and Program Delivery on the Translation of DPP to Worksites: A Randomized Controlled Trial of Fuel Your Life (2016)
This study evaluated the effectiveness of the Fuel Your Life program, an adaptation of the Diabetes Prevention Program, utilizing implementation strategies commonly used in worksite programs – telephone coaching, small group coaching, and self-study. Overall, all three approaches had a positive impact on employee weight and BMI over the course of the study. Forty percent of the phone group and one third of the small group coaching lost more than 5% of their body weight.
A Randomized Controlled Trial Translating the Diabetes Prevention Program to a University Worksite, Ohio (2015)
This study evaluated a worksite lifestyle intervention compared with usual care and found that it improved metabolic and behavioral risk factors among employees with prediabetes.
For information on the Cost-Effectiveness of the National Diabetes Prevention Program: A Real-World, 2-Year Prospective Study, visit the Cost Analysis | Employer section of this page.
To learn more about commercial and employer coverage of the National DPP lifestyle change program, visit the Commercial Payers section of the Coverage Toolkit.
Program Outcomes | Specific Populations
Includes: American Indian & Alaska Native | Gestational Diabetes | Veterans
Program Outcomes | American Indian & Alaska Native
Translating the Diabetes Prevention Program into American Indian and Alaska Native Communities (2013)
This study examined the implementation of a translational National DPP lifestyle intervention across diverse American Indian and Alaska Native (AI/AN) communities. Findings demonstrate the feasibility and potential for adapting the intervention in these settings, with important implications for broader dissemination and long-term integration within Native American health systems.
To access the CDC-approved Prevent T2 curriculum for American Indian and Alaska Native communities, visit the Curriculum page of the Coverage Toolkit.
Program Outcomes | Gestational Diabetes
Effectiveness of the National DPP After Gestational Diabetes (2023)*
In an evaluation conducted across a large network of Federally Qualified Health Centers (FQHCs), younger women with a history of gestational diabetes who participated in the National DPP lifestyle change program demonstrated one-third higher attendance and achieved twice as much weight loss as other participants. These findings contrast with prior research, which has shown lower engagement and weight loss among younger women.
*Requires subscription or payment
CDC-Recognized Diabetes Prevention Program After Gestational Diabetes Mellitus (2022)
This research recommends that individuals with a previous gestational diabetes diagnosis participate in the National DPP lifestyle change program postpartum to decrease and delay risk of developing type 2 diabetes. Authors suggest that participation in the program may also decrease participants’ risk of developing gestational diabetes in future pregnancies.
Does a History of Gestational Diabetes Mellitus Affect Key Outcomes in Women Participating in a Diabetes Prevention Program? (2017)*
This evaluation of National DPP lifestyle change program outcomes compared participation, self-monitoring behavior, weight loss, and cardiometabolic risk reduction among women with and without a previous gestational diabetes diagnosis. Authors concluded that individuals with a previous gestational diabetes diagnosis can be highly successful in the program and achieve significant weight loss.
*Requires subscription or payment
The Effect of Lifestyle Intervention and Metformin on Preventing or Delaying Diabetes Among Women with and without Gestational Diabetes (2015)*
The Diabetes Prevention Program Outcomes Study 10-year follow-up found that individuals with a previous gestational diabetes diagnosis were 48% more likely to develop type 2 diabetes than those without. It also found that successful completion of the Diabetes Prevention Program lifestyle intervention reduced progression to diabetes for these individuals by 35%.
*Requires subscription or payment
A Web-Based Lifestyle Intervention for Women with Recent Gestational Diabetes Mellitus: A Randomized Controlled Trial (2014)
This study tested the feasibility and effectiveness of a web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes. Researchers found that the program decreased postpartum weight retention in the study population, with intervention participants returning to their pre-pregnancy weight at one year while control participants remained significantly above pre-pregnancy weight.
Promoting Health After Gestational Diabetes: A National Diabetes Education Program Call to Action (2012)
This study of diabetes prevention programs for individuals with gestational diabetes found that participation can also benefit their children. Because children born from gestational diabetes pregnancies face a higher risk of obesity and type 2 diabetes, parents who adopt healthier eating and physical activity behaviors through these programs may contribute to improved long-term outcomes for their children.
To review statistics on gestational diabetes, see the Statistics and Burden | Gestational Diabetes section.
- Trends and Characteristics in Gestational Diabetes: United States (2016-2020)
- Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the United States (2011-2019)
To learn more about gestational diabetes and the National DPP lifestyle change program, visit the People with Gestational Diabetes page of the Coverage Toolkit.
Program Outcomes | Veterans
Women Veterans’ Experience with a Web-Based Diabetes Prevention Program (2015)
This qualitative study used semi-structured interviews with 15 female veterans who participated in an online diabetes prevention program. Key themes included the program’s convenience, ease of integration into daily routines, and its role in supporting accountability.
Program Implementation
Includes: Policy Recommendations | Delivery Modality | Incentives & Program Supports
Program Implementation | Policy Recommendations
Social Vulnerability and National Diabetes Prevention Program Recognition Status (2025)
In this study, researchers analyzed the 2022 National DPP registry and the 2018 CDC Social Vulnerability Index (SVI) to examine the association between SVI and CDC-recognized organizations at the county level. Compared to counties with low social vulnerability, counties with higher levels had significantly higher odds of having no CDC-recognized organizations. Researchers concluded that developing strategies to ensure organizations in these communities achieve CDC recognition is critical for program sustainability and reducing diabetes-related health disparities.
The Diabetes Prevention Gap and Opportunities to Increase Participation in Effective Interventions (2022)
This study examined trends in prediabetes prevalence, testing, and access to preventive resources in the U.S., and found that while prediabetes rates increased from 2010 to 2020, access to preventive resources remained low. Researchers recommend three actions to enhance prevention efforts: increase payment for interventions, improve data integration and patient follow-up, and extend coverage and broaden access for interventions.
Two Decades of Diabetes Prevention Efforts: A Call to Innovate and Revitalize Our Approach to Lifestyle Change (2022)
Based on current evidence and input from experts in global translational programs, this review describes key priorities for diabetes prevention efforts: expanding participant eligibility, offering less intensive interventions, adjusting content based on evolving dietary recommendations, addressing and responding to change readiness, expand use of technology in programming, and explore the role of medications. The researchers offer a conceptual framework for a broad, person-centered approach to address individual risk factors, barriers, and digital competency.
USPSTF A & B Recommendations (2021)
The United States Preventive Services Task Force (USPSTF) is an independent panel of experts that publishes recommendations for evidence-based clinical preventive services. The Affordable Care Act requires a subset of health plans to cover items and services with a grade A or B USPSTF recommendation without cost-sharing for the relevant member. The counseling requirements for abnormal blood glucose, healthful diet and physical activity, gestational diabetes, and obesity can be met through coverage of the National DPP lifestyle change program.
For more information on USPSTF Recommendations, please see the Quality Metrics page of the Coverage Toolkit.
National Clinical Care Commission: Report to Congress on Leveraging Federal Programs to Prevent and Control Diabetes and Its Complications (2021)
The National Clinical Care Commission, a federal advisory committee, outlined evidence-based, actionable recommendations to strengthen federal diabetes awareness, prevention, and treatment efforts. The report—the first of its kind since 1975—calls for expanded access to health care, greater attention to social drivers of health, and improved coordination across federal agencies. The National DPP lifestyle change program and the MDPP are prominently featured in these recommendations.
Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges (2020)
This narrative review summarizes evidence related to the reach, effectiveness, and sustainability of the National DPP lifestyle change program, while highlighting opportunities to address ongoing challenges in these areas. The authors emphasize the importance of aligning programs with the evolving evidence base, expanding reimbursement opportunities, and reevaluating pay-for-performance models to support long-term sustainability.
Program Implementation | Delivery Modality
Includes: Artificial Intelligence | Online | Telehealth
Program Implementation | Artificial Intelligence (AI)
An AI-Powered Lifestyle Intervention vs. Human Coaching in the Diabetes Prevention Program (2025)
In this randomized clinical trial of 368 adults with overweight or obesity and prediabetes, researchers compared outcomes between participants referred to an AI-led diabetes prevention program and those referred to a human-led program. At 12 months, approximately 31% of participants in each group achieved at least 5% weight loss, at least 4% weight loss plus 150 minutes of physical activity per week, or a reduction in A1c of at least .2 percentage points. Findings demonstrated that a fully automated AI-led diabetes prevention program may be a viable alternative to a program led by human coaches.
Program Implementation | Online
Effects of a Digital Diabetes Prevention Program (2022)
This randomized controlled study evaluated the effectiveness of a digital diabetes prevention program (d-DPP) — a year-long, asynchronous intervention featuring a Lifestyle Coach and cohort—compared with a control group that received a single two-hour diabetes prevention session. Participants in the d-DPP experienced significantly greater reductions in HbA1c (−2.3%) and weight (−5.49%) than those in the control group. Notably, 20% of participants were aged 65 and older, suggesting the program may be a promising strategy for Medicare populations.
Engagement and Outcomes in a Digital Diabetes Prevention Program: 3-Year Update (2017)
A non-randomized trial of participants in an online diabetes prevention program delivered by Omada Health examined the relationship between first-year engagement and sustained weight loss at three years. Participants who completed four or more sessions in the first year maintained a 3.0% weight loss, while those who completed nine or more sessions maintained a 2.9% weight loss at three years.
Outcomes of a Digital Health Program with Human Coaching for Diabetes Risk Reduction in a Medicare Population (2017)
This observational study found that Medicare beneficiaries who participated in an online diabetes prevention program sustained program engagement and improved weight, health, and well-being. Participants achieved an average weight loss of 7.5% at 12 months.
Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients (2016)
Researchers documented patient interest, engagement, and satisfaction with a digital health diabetes prevention program offered by Omada Health among low-income and Hispanic populations. However, low computer and online literacy for some of this population presented implementation challenges that should be considered in digital health adaptations for low-income populations.
Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study (2015)
In this follow-up study, participants in an online diabetes prevention program offered by Omada Health – that includes a wireless scale, virtual group sessions (10–15 participants), and access to a health coach—achieved significant and sustained reductions in body weight and A1c over two years. Among the 155 participants who completed the program, average weight loss was 4.9% at one year and 4.3% at two years. A1c levels decreased by 0.40% at one year and 0.46% at two years.
Using the Internet to Translate an Evidence-Based Lifestyle Intervention into Practice (2009)*
This study tested an adapted, online version of the Diabetes Prevention Program that was delivered using audio-narrated lessons and included e-mail prompts, automated weekly progress reports, and as-needed communication with a Lifestyle Coach. Out of 50 pilot participants, 45 completed the program. Those who completed the program lost an average of 10.6 pounds and systolic blood pressure dropped an average of 7.33 mm Hg.
*Requires subscription or payment
Information on a digital behavioral counseling prevention program delivered in a workforce is available in the Program Outcomes | Employees/Worksite section of this page.
Information on a web-based lifestyle intervention for women with recent gestational diabetes is available in the Program Outcomes | Gestational Diabetes section of this page.
Information on a web-based diabetes prevention program delivered to women veterans is available in the Program Outcomes | Veterans section of this page.
Program Implementation | Telehealth
Intent-to-Treat Analysis of a Simultaneous Multisite Telehealth Diabetes Prevention Program (2018)
This study found that delivering a modified diabetes prevention program via telehealth to multiple rural communities in Montana achieved weight loss outcomes comparable to those of an in-person intervention.
Additional Montana Telehealth Research
- From 2008–2015, researchers found similar participation rates, physical activity goals, and weight loss outcomes between in-person and telehealth delivery of a diabetes prevention program.
- In this 2009 study, both the on-site and telehealth diabetes prevention program groups achieved high levels of weekly physical activity, and there were no statistically significant differences in weight loss between the groups (45% of all participants achieved 7% weight loss or more).
Additional information about how the National DPP lifestyle change program is delivered through telehealth in Montana can be found on the Montana State Story page of the Coverage Toolkit.
Program Implementation | Incentives & Program Supports
Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: A Systematic Review and Meta-Analysis (2022)
This CDC-led systematic review and meta-analysis indicated that providing incentives in lifestyle modification programs is a promising strategy to decrease body weight, body mass index, and blood pressure.
The Effects of Financial Incentives on Diabetes Prevention Program Attendance and Weight Loss Among Low-Income Patients: The We Can Prevent Diabetes Cluster-Randomized Controlled Trial (2020)
This study compared Medicaid beneficiaries earning financial incentives based on their individual participation and weight loss, beneficiaries earning incentives based on a hybrid of individual and group participation and weight loss, and a control group receiving no incentives. Researchers found that financial incentives substantially increased program participation during core sessions and modestly during maintenance sessions. When compared to the control group, a greater proportion of both financial incentives groups attained 5% weight loss at 16 weeks, and the group-based incentives participants achieved significantly higher levels of 7-10% weight loss at 12 months.
Medicaid Incentives for the Prevention of Chronic Diseases: Final Report (2017)
The Center for Medicare and Medicaid Innovation’s (CMMI) Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) program evaluated the use of financial incentives to promote behavior change among Medicaid beneficiaries. Ten states received demonstration grants to implement incentive-based interventions, including participation in the National DPP lifestyle change program. Findings suggest that financial incentives can increase participation in health promotion programs, with some participants achieving improved outcomes, including weight loss.
Statistics & Burden
Includes: Data Sets | Children & Adolescents | Gestational Diabetes
Statistics & Burden | Data Sets
National Diabetes Statistics Report (2026)
The CDC’s National Diabetes Statistics Report provides up-to-date information on the prevalence and incidence of diabetes and prediabetes, risk factors for complications, acute and long-term complications, death, and costs. It includes information on prevalence and incidence of diabetes (diagnosed and undiagnosed, adults and children, by race/ethnicity, and within counties, states, and territories), prediabetes risk factors for complications, and coexisting conditions and complications.
U.S. Diabetes Surveillance System
CDC’s Division of Diabetes comprehensive compilation of diabetes data and trends at national, state, and county levels. Includes:
- Surveillance: Estimates and trends of diabetes prevalence, diabetes incidence, risk factors, preventive care practices, and complications.
- Analysis: Statistical tools to explore county-level relationships between diabetes, risk factors, and social determinants of health.
- National Diabetes Statistics Report: An interactive report card on the current state of diabetes, risk factors, quality of care, and related complications in the U.S.
- Spotlight: Featured diabetes data insights, highlighting the latest statistics.
Diabetes Statistics by State, American Diabetes Association
State-specific fact sheets on the burden of diabetes.
City Health Dashboard
The City Health Dashboard offers data on over 45 measures of health and drivers of health for over 1,200 cities across the U.S. Data is categorized by health outcomes, social and economic factors, health behavior, and clinical care, and can be view by city, zip code, or census track.
The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR): Unique 1.4M Patient Electronic Health Record Cohort (2020)
This study used a novel electronic health record (EHR) approach to examine known and emerging risk factors for type 2 diabetes and to assess how prevention interventions influence disease progression and onset. The study created an electronic cohort of 1.4 million adults who had at least four health care encounters over a minimum of 24 months, were aged 18 or older, and had no diabetes at baseline or within the first 12 months of follow-up. Over the seven-year study period, approximately 5.9% of participants (82,922 individuals) developed type 2 diabetes.
Statistics & Burden | Children & Adolescents
Pediatric Diabetes Prevalence Among Medicaid Beneficiaries (2026)
In this cross-sectional study of 25-30 million youths enrolled in Medicaid and Children’s Health Insurance Program across 43 states, pediatric type 1 and type 2 diabetes prevalence increased by 11.4% from 2016 to 2021. The largest increases occurred among males, Hispanic youths, urban youths, and residents of the western U.S.
Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the United States (2021)
Using data from the CDC- and NIH-sponsored SEARCH for Diabetes in Youth Study, researchers found that from 2001 to 2017, the number of youth aged 0–19 living with type 1 diabetes increased by 45%, while the number with type 2 diabetes nearly doubled. The study also found that the largest increases in type 1 diabetes occurred among White and Black youth, while type 2 diabetes rose most sharply among Black and Hispanic youth.
Statistics & Burden | Gestational Diabetes
Trends and Characteristics in Gestational Diabetes: United States, 2016 – 2020 (2022)
Among women giving birth in the United States in 2020, the prevalence of gestational diabetes mellitus (GDM) was 7.8%—a 30% increase from 2016. Rates rose by an average of 5% annually from 2016 to 2019, followed by a sharper 13% increase from 2019 to 2020.This report examines trends and disparities in GDM rates from 2016 through 2020 by maternal race and Hispanic origin, age, body mass index (BMI), birth plurality, and state of residence.
Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the U.S., 2011 – 2019 (2021)
A serial cross-sectional analysis of National Center for Health Statistics data—including 12,610,235 women aged 15 to 44 with singleton first live births—found that gestational diabetes rates rose from 47.6 to 63.5 per 1,000 live births between 2011 and 2019.
Cost Analysis
Includes: Economic Costs of Diabetes | Cost Effectiveness & ROI
Cost Analysis | Economic Costs of Diabetes
Economic Costs Attributed to Diagnosed Diabetes in Each U.S. State and the District of Columbia (2024)
This research presents state-specific estimates of direct and indirect diabetes-attributable costs in the U.S. across state Medicaid, Medicare, and other payers and assesses changes in spending from 2013 to 2021. Researchers conclude that state economic costs of diagnosed diabetes are substantial and increased over the last decade.
Economic Costs of Diabetes in the U.S. in 2022 (2023)
These figures from the American Diabetes Association (ADA) indicate direct and indirect estimated annual costs of $412.9 billion as a result of diabetes. Individuals with diabetes face on average 2.6 times higher health care costs than those without diabetes, and 1 in 4 health care dollars are spent treating diabetes and its complications.
Trends in Medical Expenditures Prior to Diabetes Diagnosis (2021)
This analysis found that increases in diabetes-related costs begin at least five years before diagnosis and accelerate immediately afterward. Newly diagnosed individuals incurred $8,941 more in medical expenses than matched controls over a five-year period, including approximately $4,828 in the year of diagnosis.
Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes (2017)
Researchers evaluated the differences in health care costs between individuals with prediabetes who progress to type 2 diabetes versus those who do not. They found medical expenditures to be nearly one-third higher for those who develop diabetes, demonstrating the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of the disease.
Cost Analysis | Cost Effectiveness & ROI
Includes: General | Employers | Medicaid | Medicare | Online Delivery
General
Cost Effectiveness of Nonpharmacological Prevention Programs for Diabetes: A Systematic Review of Trial-Based Studies (2023)
Researchers reviewed the cost-effectiveness of non-medication-based interventions to prevent type 2 diabetes in people at high risk for the disease, finding that both DPP-based and non-DPP-based interventions were cost-effective and feasible. DPP-based programs resulted in larger decreases in diabetes incidence, and the best cost-effectiveness outcomes were found in combined in-person and virtual delivery options.
Cost Effectiveness of Diabetes Prevention Interventions Targeting High-Risk Individuals and Whole Populations: A Systematic Review (2020)
A systematic review of cost-effectiveness in diabetes prevention found that both high-risk and population-based strategies are efficient uses of resources. Although all approaches were found to be cost-effective, their relative impact varied. Lifestyle interventions were more cost-effective than pharmacological approaches, and translational DPP interventions were significantly more cost-effective than non-DPP interventions.
The Value of a Return on Investment in Promoting Prevention: One Center’s Journey and Perspective (2017)
The endocrinology center of a large nonprofit health system in Missoula, Montana describes their implementation of the National DPP lifestyle change program, including the path to coverage and the cost-benefit and ROI of the program.
Diabetes Prevention Programs: Effectiveness and Value (2016)
The Institute for Clinical and Economic Review report used a potential budget impact model and estimated cost savings of $1,146 per participant for in-person classes and $618 for online (over a five-year horizon). For private payers, the report recommended that the National DPP lifestyle change program be covered using a pay-for-performance model across all lines of business and products, and that payers should encourage their clinical networks to support active outreach and screening for prediabetes.
The Cost-Effectiveness of Diabetes Prevention: Results from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Stud (2015)
A review of the original Diabetes Prevention Program (DPP) clinical trial and 10-year Diabetes Prevention Program Outcomes Study was conducted from the perspective of resource utilization, costs of the interventions, costs of the non-intervention medical care, the impact of the interventions on diabetes progression and quality of life, and the cost-effectiveness of the interventions from health system and societal perspectives. The data was analyzed over 3- and 10-year periods and indicated cost-efficacy and quality of life improvements for high-risk individuals.
Diabetes Prevention and Control: Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among People at Increased Risk (2015)
The Community Preventive Services Task Force conducted an economic review of 28 studies published between January 1985 and April 2015 and found that combined diet and physical activity promotion programs for individuals at increased risk for type 2 diabetes are cost-effective.
Twenty-one of the studies evaluated cost-effectiveness from the health system perspective by estimating incremental cost-effectiveness ratios (ICERs), using direct medical costs associated with program delivery and medical costs avoided through the prevention or delay of type 2 diabetes and its complications. Across these studies, the median ICER for combined diet and physical activity programs was $13,761 per quality-adjusted life year (QALY) gained (interquartile interval [IQI]: $3,067–$21,899; 16 studies). Variation in ICER estimates was attributed to differences in program cost and effectiveness, delivery methods, follow-up duration, and care settings.
Information on the cost effectiveness of the DPP research study is located in the Program Outcomes | Original & Translational Research Studies section of this page.
Cost Analysis | Employers
Cost-Effectiveness of the National Diabetes Prevention Program: A Real-World, 2-Year Prospective Study (2024)
This study assessed the cost-effectiveness of the National DPP lifestyle change program in a large workforce with employer-sponsored insurance. The analysis found that participants had an average reduction of $4,552 in two-year total direct medical costs, primarily related to reductions in hospitalizations, outpatient visits, and emergency room visits. It also found that enrollment in the program had an 88% probability of saving money.
Cost Analysis | Medicaid
Implementing Lifestyle Change Interventions to Prevent Type 2 Diabetes in U.S. Medicaid Programs: Cost Effectiveness, and Cost, Health, and Health Equity Impact (2020)
This study reviewed data (including representative surveys, cohort studies, Medicaid claims data, and published literature) from eight states (Alabama, California, Connecticut, Florida, Iowa, Illinois, New York, Oklahoma) to estimate the long-term health and economic implications of implementing DPP-based programs in Medicaid. Researchers concluded that paying for lifestyle change programs is probably a highly cost-effective policy in most state Medicaid programs.
The Cost of Diabetes in Medicaid: A Review of the Research (2009 – 2018)
Several research studies demonstrate the costs of diabetes related care in Medicaid. A few examples of these studies are summarized in this table which also highlights the methodology and data sources used.
Cost Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries (2018)*
Researchers evaluated 847 Medicaid enrollees at high risk for type 2 diabetes who participated in the National DPP lifestyle change program. Participants received program supports including transportation, childcare, access to exercise facilities, and two $25 monetary incentives.
On average, participants attended 12 sessions, lost 4.2 pounds over a median of 17 weeks, and increased high-density lipoprotein (HDL) cholesterol by 1.75 mg/dL. The intervention cost $915 per participant and was considered cost-effective by commonly accepted standards, even when assuming that only 50% of weight loss was maintained over five years.
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Progression to Type 2 Diabetes and Its Effect on Health Care Costs in Low-Income and Insured Patients with Prediabetes: A Retrospective Study Using Medicaid Claims Data (2017)
This study used South Carolina Medicaid claims data (2009-2014) to identify adults with newly diagnosed prediabetes, finding that progression to type 2 diabetes significantly increased total health care costs in the first three years after diagnosis.
Cost Analysis | Medicare
Information on the following studies, which include cost information, can be found in the Program Outcomes | Medicare DPP section of this page.
Cost Analysis | Online Delivery
Return on Investment for Digital Behavioral Counseling in Patients with Prediabetes and Cardiovascular Disease (2016)
This study evaluated 2,371 individuals with prediabetes or at risk for cardiovascular disease who were enrolled in an online prevention program through Omada Health (2012 – 2014). Researchers simulated clinical and economic outcomes over a 10-year period, based on 26-week weight loss results from the program. The model estimated a return-on-investment break-even point at three years for both populations, with a five-year ROI of $1,565 per participant in the prediabetes group.
Additional Benefits of Prevention
Includes: Cardiovascular and Metabolic Syndrome | Cognitive Health | Sleep Apnea | Quality of Life
Additional Benefits | Cardiovascular and Metabolic Syndrome
Prediabetes Remission and Cardiovascular Morbidity and Mortality: Post-Hoc Analyses from the Diabetes Prevention Program Outcome Study and the DaQing Diabetes Prevention Outcome Study (2026)
Based on post-hoc analyses from the U.S. Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Prevention Outcome Study (DaQingDPOS), researchers found that reaching prediabetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalization for heart failure in diverse populations.
Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in U.S. Settings: A Systematic Review and Meta-Analysis (2016)
This study analyzed forty-four studies with a total of almost 9,000 participants and found that DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements, including blood pressure, cholesterol, and blood sugar.
Long-Term Effects of the Diabetes Prevention Program Interventions on Cardiovascular Risk Factors: A Report from the DPP Outcomes Study (2013)
The 10-year Diabetes Prevention Program Outcomes Study found major reductions for systolic and diastolic blood pressure, and for LDL cholesterol and triglycerides in all groups (lifestyle intervention, metformin, and placebo). Lipid and blood pressure medication use were lower for the lifestyle intervention group than in the other two groups.
Cardiovascular Mortality, All-cause Mortality, and Diabetes Incidence after Lifestyle Intervention for People with Impaired Glucose Tolerance in the Da Qing Diabetes Prevention Study: A 23-Year Follow-Up Study (2014)
A 23-year follow up of people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study found that cumulative cardiovascular disease mortality decreased from 19.6% in the control group to 11.9% in the group who received a lifestyle intervention.
The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial (2005)
A secondary analysis from the Diabetes Prevention Program (DPP) clinical trial found that both lifestyle intervention and metformin reduced the incidence of metabolic syndrome among participants who did not have it at baseline. Incidence was reduced by 41% in the lifestyle intervention group and 17% in the metformin group.
Additional Benefits | Cognitive Health
HbA1c and Brain Health Across the Entire Glycemic Spectrum (2021)
This study found that both prediabetes and diabetes are harmful in terms of vascular dementia, cognitive decline, and Alzheimer’s dementia. Low-normal HbA1c levels were also found to be associated with more favorable brain health outcomes.
Additional Benefits | Sleep Apnea
Weight Loss from Lifestyle Interventions and Severity of Sleep Apnea: A Systematic Review and Meta-Analysis (2014)
An analysis of two systematic reviews and eight randomized control trials of overweight or obese individuals with obstructive sleep apnea found that intensive lifestyle interventions led to significant weight loss and reduced sleep apnea severity.
Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes (2013)
A study of adults with obesity, type 2 diabetes, and obstructive sleep apnea found that over four years, intensive lifestyle intervention led to greater reductions in weight and sleep apnea severity compared with diabetes support and education alone.
The Impact of Diet and Lifestyle Management Strategies for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials (2013)
A systematic review and meta-analysis of 12 controlled trials found that intensive lifestyle management significantly reduced obesity measures and decreased the severity of sleep apnea.
Additional Benefits | Quality of Life
Changes in Health State Utilities with Changes in Body Mass in the Diabetes Prevention Program (2009)
An analysis of the Diabetes Prevention Program clinical trial data concluded that weight loss achieved due to the lifestyle intervention was associated with improvements in measures of health-related quality of life (HRQL), which are used in cost-effectiveness research.
