Millions of Americans Have Diabetes or Prediabetes and Don’t Know It

Diabetes has quietly become one of the biggest health issues in the country. Yet a surprising number of people who have it, or its precursor, prediabetes, don’t even know.

According to the CDC, more than 115 million American adults now live with prediabetes. That’s over two in five adults. Here’s the alarming part: roughly eight in ten of them have no idea.

That matters because early detection changes everything. Catching prediabetes early gives people a real shot at reversing it before it turns into full-blown type 2 diabetes.

So how do doctors actually diagnose it? Usually through simple blood tests. An A1C test or a fasting glucose test can reveal whether blood sugar levels fall within the normal range, a prediabetic range, or a diabetic range.

Type 2 diabetes makes up the vast majority of cases, somewhere between 90 and 95 percent. Type 1 diabetes, which is an autoimmune condition, accounts for the rest. The two aren’t the same disease, and they don’t develop the same way.

Several factors raise your risk. Carrying excess weight, staying inactive, and having a family history of diabetes all play a role. None of them guarantee you’ll develop the condition, but they do stack the odds.

Left unchecked, high blood sugar doesn’t just sit quietly in the background. Over time, it damages blood vessels and nerves. It can also harm your kidneys, your eyes, and your heart.

Even prediabetes isn’t harmless on its own. Research shows it can raise the risk of heart disease before diabetes is ever officially diagnosed. In other words, the damage can start earlier than most people realize.

There’s also a financial side to all this. Diabetes accounted for about 25 percent of total U.S. health care spending, driving up costs for patients and the system alike. People with diabetes typically face medical bills more than double those without it.

Employers feel the impact too. Lost productivity and higher absenteeism add up, creating costs that ripple far beyond the doctor’s office.

The good news is that prevention efforts do exist and they work. The CDC runs the National Diabetes Prevention Program, which helps high-risk adults make lasting lifestyle changes. Participants who lose even a modest amount of weight and become more active can cut their risk of diabetes in half.

Screening guidelines have also evolved. The U.S. Preventive Services Task Force now recommends diabetes screening for adults with a higher body mass index or other risk factors. Doctors may prescribe metformin or other FDA-approved medications once a diagnosis is confirmed.

For people already managing type 2 diabetes, treatment usually combines lifestyle changes with medication. GLP-1 receptor agonists and similar drugs can help lower blood sugar, but they require a prescription and ongoing medical supervision.

Given how many cases go undiagnosed, routine screening remains one of the simplest tools available. A quick blood test could catch a problem years before symptoms ever show up. And for millions of Americans, that early warning could make all the difference.