North Carolina’s diabetes burden is not evenly distributed, with higher rates reported in counties facing barriers to health care. Andrew Tucker’s experience offers one view of the disease’s daily demands: diagnosed with Type 2 diabetes at 35, when he weighed about 250 pounds, he learned it ran in his family through his father and grandfather. Nearly 15 years later, he manages it with a continuous glucose monitor, dietary changes and daily attention to his blood sugar. Health officials say many other North Carolinians may have diabetes without knowing it.
Endocrinologist Dr. Adam Spitz, who practices with Novant Health, estimates that about 1 million people in North Carolina have diabetes and roughly 250,000 have undiagnosed diabetes. He estimates another 3 million North Carolinians have prediabetes, which can progress to diabetes but may also be addressed with preventive steps. North Carolina is considered part of the Diabetes Belt, a region with elevated diabetes rates, and Spitz says diagnoses in the state have continued to climb despite advances in treatment.
Undiagnosed diabetes is also a substantial national concern, though published estimates vary. Drawing on 2023 data, the American Diabetes Association reported that 29.1 million of the 40.1 million people living with diabetes nationwide had been diagnosed, while 11 million had not, according to diabetes.org. A separate CDC data snapshot also estimated 11 million people, or 27.6% of adults with diabetes, were undiagnosed; that estimate carries lower confidence because only a partial data snippet is available. A North Carolina television report covering this story cited a national total of about 40 million, rather than 40.1 million. The available reporting does not resolve the difference.
Why So Many Cases Slip Through
Undiagnosed diabetes is dangerous precisely because it can progress silently. People can begin developing complications without even knowing they have the disease, Spitz has said, according to a report from WBTV. Left unmanaged, high blood sugar can contribute to heart disease, kidney failure, and vision loss, per research from the Carolina Population Center at UNC's Carolina Demography. Nationally, diabetes is linked to a broader list of long-term complications, including coronary artery disease, heart attacks, nerve damage, and amputations, and the American Diabetes Association has identified Type 2 diabetes as the leading cause of amputation in the United States. Diabetes also ranks as the seventh leading cause of death nationwide and is considered the leading cause of kidney disease.
Type 2 diabetes develops when the body does not produce enough insulin or does not use it properly, and obesity is considered a major risk factor. The condition can often be prevented or delayed through improved diet and regular exercise. People experiencing possible warning signs — including excessive thirst, extreme fatigue, and frequent urination — are advised to consult a doctor for further testing.
A County-By-County Divide
Diabetes continues to hit the South especially hard, and within North Carolina the burden is not spread evenly. In 2021, 15.8% of North Carolina adults had been diagnosed with diabetes, compared with roughly 6% to 12% across most U.S. counties that same year, according to the Carolina Demography analysis. Sampson County reported the state's highest prevalence at 13.5%, followed by Robeson County at 13.1% and Scotland County at 12.4%. The same analysis found higher diabetes rates tend to cluster in counties with limited health care access, lower educational attainment, and lower median incomes — and those three counties also posted some of the state's highest uninsured rates, at 24.8% in Sampson, 22.3% in Robeson, and 20.0% in Scotland.
Spitz has pointed to rural and underserved communities as facing particular barriers, including limited access to health care and to education about healthy lifestyle changes, according to the same WBTV report. Separately, CDC researchers have found that rural diabetes prevalence varies widely by state, ranging from 8.4% in Colorado to 21.3% in North Carolina in 2021, though that comparison is drawn from a lower-confidence CDC data source.
Coverage and prevention efforts
One change to coverage access came in December 2023: according to the North Carolina Governor’s Office, Medicaid expansion made adults ages 19–64 with incomes up to 138% of the federal poverty level eligible for coverage. The expansion is relevant access context, but it does not establish that undiagnosed diabetes has declined. For prevention, the North Carolina Department of Health and Human Services says its Minority Diabetes Prevention Program offers a 12-month lifestyle class series for people with prediabetes or at high risk, using a CDC-developed curriculum in English and Spanish. In a report on fiscal year 2022–23, NCDHHS said the program’s regional collaboratives screened 4,776 people for prediabetes, exceeding a target of 1,875 by June 30, 2023, according to the department’s report. That is a screening count, not a count of diabetes diagnoses.
Tucker's Daily Management
Tucker says he changed his diet and began exercising regularly after his diagnosis, eventually losing more than 30 pounds. He now uses a continuous glucose monitor to track his blood sugar. At a recent appointment, a doctor shown in video from the original report said Tucker’s average blood sugar was 129 and improving compared with his prior visit.
Spitz says GLP-1 drugs such as Ozempic and Wegovy have helped many patients manage diabetes, even as diagnoses in North Carolina continue to rise. Persistent thirst, fatigue or frequent urination are reasons to consult a doctor; testing is needed to determine whether someone has diabetes. This story was originally reported by Live 5 News.
