Chronic Illness and Diabetes in America

The population of the United States is seeing a rise in chronic disease, with a projected increase from 129 million chronically ill Americans  in 2024 to 221 million in 2050. As the percentage of people with chronic disease increases, healthcare costs for treating these conditions also increase. Currently, the economic impact of chronic disease in America sits at $3.7 trillion. 

Diabetes is one chronic illness that is particularly prevalent. In the U.S., 38 million people, or 11.6% of the population, are living with diabetes. Diabetes costs the nation’s public health agencies $413 billion, with complications associated with T2D, such as stroke and heart disease accounting for at least approximately 50% of costs. The two forms of the illness are type 1 and type 2 diabetes. Type 1 diabetes (T1D) is an autoimmune condition that requires lifelong insulin treatment and cannot be cured through lifestyle changes. Type 2 diabetes (T2D), which accounts for the vast majority of cases, develops when the body becomes resistant to blood sugar or does not produce enough of it, often linked to factors such as diet, physical activity, and genetics. 

Those at greatest risk of developing T2D face compounding disadvantages. Research identifies non-white race, lower educational attainment, higher poverty rates, and rural or nonmetropolitan residence as key risk factors for developing T2D. These populations are also the least likely to have access to preventive care. Rates are increasing most sharply in the southern United States, where these disparities converge. 

Unlike T1D, T2D can often be prevented or delayed through lifestyle changes, making it a central focus of national public health efforts like the Diabetes Prevention Program..

What is the Diabetes Prevention Program?

The Diabetes Prevention Program (DPP) is a national lifestyle change program targeting the 115 million American adults living with prediabetes, a population for whom early intervention is critical to prevent the onset of diabetes. Originally piloted in a 2001 clinical research study led by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), the program showed that lifestyle interventions could significantly reduce the risk of developing T2D. Building on these findings, the CDC’s National Diabetes Prevention Program was established in 2010 to expand access nationwide.  

Federal policy helped create the basis for the DPP before its formal establishment by the CDC. In 2010, prevention services became a key goal for American public health due to the rising economic burden and increasing death rates associated with chronic illness like diabetes. In March 2010, , the Affordable Care Act created the Prevention and Public Health Fund, which provides funding for the DPP and other community-based interventions and that prevent long-term healthcare costs. 

How Does the DPP Work? 

The DPP operates through partnerships with community organizations, private insurers, employers, healthcare organizations, faith-based organizations, and government agencies. Standards set by the Centers for Disease Control and Prevention (CDC) determine the curriculum, ensuring a uniform lifestyle-change program across the country. Core program activities include healthy eating, weight loss of 5–7% with 150 minutes of exercise per week throughout the year, and stress management, alongside tailored activities to support long-term behavior change.

For clients, DPP programs are funded through a mix of Medicare, Medicaid, private insurance, employer-sponsored coverage, and, in some cases, out-of-pocket payments.

Since its implementation, the program has reached a participant base of 750,000 adults since the inception of the program to March 2024, alongside prediabetes awareness campaigns notifying 12 million people of their risk status. However, participation remains relatively low compared to the size of the at-risk population.

Is the DPP Effective? 

Research suggests that the DPP can reduce the risk of developing T2D by over 50% among participants through nutrition and exercise support. Long-term follow-up data indicate that program participants delayed the onset of T2D and associated cardiovascular events by an average of 15 years, demonstrating sustained impacts over time.

The program has also been associated with reduced healthcare costs. The program saves an estimated $1,146 per participant in diabetes-related healthcare costs, and is often cited as a cost-effective tool to address the growing diabetes epidemic. 

At the same time, evidence points to variation in outcomes. Prevention programs like the DPP do not eliminate cardiovascular risk entirely; in one study, 37 deaths from cardiovascular complications occurred among participants who completed prevention-oriented lifestyle changes. This rate of cardiovascular death was comparable to non-participants, suggesting that for some individuals, lifestyle interventions like the DPP program alone may be insufficient.

Disparities in both diabetes risk and access to prevention programs persist. Research identifies non-white race, lower educational attainment, higher poverty rates, and rural or nonmetropolitan residence as key risk factors for developing T2D. These populations are also the least likely to have access to preventive care. Rates are increasing most sharply in the southern United States, where these disparities converge. Additionally, two thirds of adults experiencing food insecurity are at increased risk of developing T2D, reflecting structural barriers such as limited access to nutritious food. 

Funding Cuts and Future Outlook

The long-term sustainability of the DPP may be influenced by changes in federal public health funding, including proposed cuts to the Prevention and Public Health Fund.

These funding shifts occur alongside broader trends in public health spending. With a decline of more than half of the budget for CDC diabetes research and prevention, millions of reliant Americans stand to lose access to programs for chronic disease prevention, potentially increasing long-term healthcare costs.

At the same time, projections estimate continued investment in chronic disease prevention from private foundations, reflecting ongoing discussions about how best to supplement government spending on prevention and treatment.

Frequently Asked Questions