Key Takeaways
- In 2024, the national incidence rate of type I diabetes was 24.0 per 100,000 persons under age 20, but state-level rates ranged from 17.0 to 27.8.
- The ratio of board-certified pediatric endocrinologists to patients with type 1 diabetes also varied widely.
- Three states had fewer than five pediatric endocrinologists per 1,000 patients under age 18; in contrast, Washington, D.C. had 46.4.
Wide variations in the numbers of type 1 diabetes patients and specialists throughout the U.S. may affect care availability as diagnostic and treatment modalities continue to advance, data from a cross-sectional study indicated.
In 2024, the national incidence rate was 24.0 per 100,000 individuals under age 20, but state-level rates ranged from 17.0 to 27.8, reported Fei Wang, PhD, of Breakthrough T1D in St. Leonards, Australia, and colleagues.
"Such data provide vital information for understanding the burden of disease and guide health service delivery and resource allocation to enable equitable access to care irrespective of where individuals live," the authors wrote in a JAMA Network Open research letter.
"National-level incidence and prevalence estimates may mask within-country variation," they pointed out.
States with the lowest estimated incidence per 100,000 youth under age 20 were Hawaii (17.0), New Mexico (20.5), and California (20.6). The highest rates were found in West Virginia (27.8), Maine (27.4), and Vermont (27.4).
Overall, 1,476,859 U.S. individuals of all ages were living with type 1 diabetes in 2024. California (154,949) and Texas (123,329) had the highest prevalence, while Wyoming (2,720) and Washington, D.C. (2,810) had the lowest. Among youth under 20, there were 196,778 living with the condition, with California and Texas again showing the highest numbers, and Washington, D.C. and Wyoming the lowest.
Wang's team also identified marked disparities in access to specialized care, specifically in the ratio of board-certified pediatric endocrinologists to patients with type 1 diabetes.
Nebraska, Mississippi, North Dakota, and New Mexico each had fewer than five pediatric endocrinologists per 1,000 patients younger than 18. In contrast, Washington, D.C. recorded the highest ratio at 46.4, followed by Rhode Island (22.5) and Massachusetts (20.7).
"Demand for pediatric endocrinologists (and multidisciplinary team members, such as diabetes educators and dietitians) will likely increase as type 1 diabetes screening identifies more individuals at risk ... new drug interventions are approved, and diabetes technologies advance. Therefore, steps should be taken to address this inequity and prevent it from widening," they urged.
Wang told MedPage Today that geography functions as "effectively a clinical variable -- same disease, very different access."
Excluding Washington, D.C., the researchers found that the number of pediatric endocrinologists in some states was six to eight times higher than in others. Wang noted that this gap is "far sharper than variation in primary care physicians (about twofold) or specialists generally (two- to fourfold) -- and most of the thinnest-staffed states have at or above the national average incidence."
Ultimately, the researchers hope these state-level estimates serve two practical functions, Wang said.
First, for individuals living with type 1 diabetes, the findings "give a clearer picture of where specialist capacity actually sits -- including the option of seeking care across a state line when their own state is thinly served, which is already common along borders and worth planning for deliberately rather than discovering by accident."
Second, for national policymakers, the data serves as a framework for targeted investment. "It identifies which states need workforce investment, training pipelines, and telehealth or shared-care support most urgently, rather than distributing resources evenly across a population where need clearly is not even," Wang added.
In this analysis, the researchers applied the Type 1 Diabetes Index model to estimated incidence figures using data from the U.S. SEARCH for Diabetes in Youth Study, alongside adult incidence estimates and publicly available state demographic data regarding age, race, and ethnicity.
Study limitations included gaps in available data and varying diagnostic criteria used for adult populations.
Facts Only
* The national incidence rate of type 1 diabetes in 2024 was 24.0 per 100,000 persons under age 20.
* State-level rates for this incidence ranged from 17.0 to 27.8.
* 1,476,859 U.S. individuals of all ages lived with type 1 diabetes in 2024.
* California (154,949) and Texas (123,329) had the highest prevalence among those living with type 1 diabetes.
* Washington, D.C. (2,810) and Wyoming (2,720) had the lowest prevalence among those living with type 1 diabetes.
* Among youth under 20, 196,778 individuals lived with type 1 diabetes; California and Texas showed the highest numbers, while Washington, D.C. and Wyoming showed the lowest.
* In terms of specialist access, Nebraska, Mississippi, North Dakota, and New Mexico each had fewer than five pediatric endocrinologists per 1,000 patients younger than 18.
* Washington, D.C. recorded the highest ratio of pediatric endocrinologists at 46.4 among patients under 18.
* The study applied the Type 1 Diabetes Index model using U.S. SEARCH for Diabetes in Youth Study data and adult incidence estimates.
Executive Summary
The national incidence rate for type 1 diabetes in 2024 was 24.0 per 100,000 persons under age 20, with state-level rates ranging from 17.0 to 27.8. The prevalence of type 1 diabetes among individuals of all ages in the U.S. in 2024 was approximately 1,476,859. Among youth under 20, there were 196,778 living with the condition, with California and Texas showing the highest numbers, and Washington, D.C. and Wyoming having the lowest.
Disparities exist in access to specialized care, as reflected by the ratio of board-certified pediatric endocrinologists to patients with type 1 diabetes. States like Nebraska, Mississippi, North Dakota, and New Mexico had fewer than five pediatric endocrinologists per 1,000 patients under 18, whereas Washington, D.C. had the highest ratio at 46.4. This geographic variation suggests that location functions as a clinical variable affecting access to care.
The researchers suggest that these variations in incidence and specialist availability indicate inequities in health service delivery. The findings aim to provide information for guiding resource allocation and ensuring equitable access to diabetes care, suggesting targeted investment strategies for states facing specialist shortages.
Full Take
The data explicitly demonstrates that epidemiological statistics can mask significant underlying geographic disparities in healthcare access. The fact that national incidence rates do not perfectly align with state-level variations, and the wide disparity in specialist ratios, establishes geography as a potent determinant of health equity, rather than just a setting for disease occurrence. The observation that states with high incidence often correlate with those having fewer specialists suggests a feedback loop: areas with higher burden may be systematically underserviced.
The call to action—targeting workforce investment and resource allocation—moves the conversation beyond descriptive statistics into the realm of systemic accountability. The distinction made between variations in primary care physicians versus specialist availability highlights a structural gap, suggesting that solving diabetes management requires not just increasing general medical coverage but specifically addressing the specialized capacity needed for complex chronic disease care across state lines. This framework forces a recognition that equitable access is not achieved by simple distribution but by intentional intervention against structural inertia.
What happens when policymakers focus solely on the national average or simply distribute resources evenly? This analysis suggests that inaction risks entrenching existing inequalities by ignoring the specific spatial logic of need. How can health systems be redesigned to prioritize capacity based on observed clinical variability rather than uniform demographic distribution? What are the implicit political costs associated with acknowledging this spatial causality in public health budgeting?
Sentinel — Human
The text appears to be a faithful, well-structured report of specific epidemiological research findings, likely written or heavily edited by a human analyst synthesizing academic results for public understanding.