Objective:To evaluate primary care providers' attitudes and practices regarding albuminuria testing in patients with type 2 diabetes in the United States. Methods:Using a web-based opt-in panel of providers (Porter Novelli DocStyles survey, Fall 2024), we conducted a cross-sectional study to assess attitudes toward albuminuria testing, adherence to guidelines, and reported barriers. Associations were estimated using multivariable Poisson regression. Results:Among 1236 providers who see at least one patient with diabetes weekly, 90.0% supported albuminuria testing and 83.3% agreed that annual testing helps with diabetes prognosis. Adherence to recommended urine testing-defined as correct test type, concurrent urine creatinine measurement, and recommended testing frequency-ranged from 52% to 68%. Lower adherence was associated with inpatient practice, being a nurse practitioner or physician assistant, lack of a urinalysis reminder system, perceived guideline ambiguity or time constraints, and lower diabetes patient volume. Conclusions:Despite most providers supporting urine testing for patients with diabetes, significant gaps between knowledge and practice were identified. Clinical decision support tools and clearer recommendations may help close the gaps between the guideline recommendations and practice.

Little is known about disparities in access to preventive care among people of multiple races, who are often aggregated into a single category, despite comprising a heterogeneous population. We therefore described the prevalence of barriers to preventive care for type 2 diabetes among US adults, by disaggregated subgroups of multiple races. In a pooled cross-sectional study of adults eligible for type 2 diabetes screening from the Behavioral Risk Factor Surveillance System (2013–2022), we evaluated the prevalence of: being uninsured, not having a primary care doctor, healthcare cost concerns in the past 12 months, and not having a physical exam in the past 12 months. Among 3,301,491 adults eligible for type 2 diabetes screening, mean age was 52.2 years and 52.3

RATIONALE & OBJECTIVE:Chronic kidney disease (CKD) is one of the most highly prevalent chronic conditions in the United States and associated with a high risk of premature death, particularly from cardiovascular disease. However, contemporary national trends in all-cause mortality among adults with CKD in the United States remain unclear. This study examined trends in all-cause mortality among US adults with CKD from 1999 to 2019. STUDY DESIGN:Observational cohort study. SETTING & PARTICIPANTS:Adults aged ≥20 years who participated in the 1999-2016 National Health and Nutrition Examination Survey (NHANES), with mortality follow-up through December 2019. EXPOSURE:CKD defined by an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or a urinary albumin-creatinine ratio ≥ 30 mg/g. OUTCOME:All-cause mortality. ANALYTICAL APPROACH:Age-standardized all-cause mortality rates were estimated for 3 survey periods: 1999-2004, 2005-2010, and 2011-2016. Average percent change (APC) in age-standardized mortality and adjusted relative risk (RR) of CKD-associated mortality for each survey period were estimated. RESULTS:Age-standardized mortality rate was 23.0 deaths/1,000 person-years (95% CI, 19.8-26.2) among adults with CKD surveyed 1999-2004 and 21.8 deaths/1,000 person-years (95% CI, 18.8-24.9) for those surveyed 2011-2016 (APC, -0.4% [95% CI, -1.4 to 0.5]). In contrast to men whose mortality declined (APC, -3.0 [95% CI, -3.5 to -2.6]), mortality rates increased among women with CKD (APC, 2.3 [95% CI, 1.7-3.0]). Adjusted RRs for CKD-associated mortality remained approximately 2-fold higher compared with adults without CKD across all time periods. LIMITATIONS:The cross-sectional design of NHANES precludes analysis of CKD progression or incident CKD during follow-up. CONCLUSIONS:All-cause mortality remained stable among adults with CKD and was about 2 times higher than for those without CKD. However, increasing mortality trends in specific demographic subpopulations may indicate the need for focused public health strategies and further research to address and reduce mortality disparities.

Background and aimsIncreasing prevalence of anxiety and depression are found in patients with inflammatory bowel disease (IBD). Altered gut microbiome may affect the brain, resulting in psychiatric symptoms. We aimed to analyze the feature of gut microbiota in IBD patients with anxiety or depression.MethodsAnxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS). Stool samples were collected from IBD patients, and the 16S rRNA sequencing was used to detect fecal microbiota. Metabolites were detected by Liquid Chromatography-Mass Spectrometry (LC-MS).ResultsAmong the involved IBD patients (n = 59), 28.81% had anxiety and 33.90% had depression. Linear discriminant analysis Effect Size (LEfSe) (LDA > 3.0) revealed that 4 genera (Klebsiella, Alloprevotella, Barnesiella, Bacillus) were enriched, while Sellimonas was depleted in the anxiety group. Enrichment of 2 genera (Ruminococcus, Barnesiella) were found in the depression group. In the anxiety group, valine, leucine and isoleucine degradation was enriched in fecal microbiota, with upregulation of 3-methyl-2-oxobutanoic acid involved in the above pathway. In the depression group, butanoate metabolism was enriched in fecal microbiota, with alpha-ketoglutaric acid involved. Lysine degradation were enriched in fecal microbiota, with pipecolic acid involved. Primary bile acid biosynthesis was depleted in fecal microbiota, with glycocholic acid involved. Pearson correlation analysis revealed a positive correlation between Alloprevotella and 3-methyl-2-oxobutanoic acid in the anxiety group. In patients with both anxiety and depression, four genera (Subdoligranulum, Alloprevotella, Christensenellaceae R-7 group, Barnesiella) were positively correlated with alpha-ketoglutaric acid.ConclusionIn this study, the alteration of composition of fecal microbiota was identified, and differential genus associated with IBD patients with anxiety or depression or both were explored. Change in function of microbiota was also discovered by the detection of differential pathways and fecal metabolites, which were associated with IBD patients with anxiety or depression or both.

Background The prevalence of cardiometabolic risk factors may vary by disaggregated race and ethnicity categories, and by acculturation‐related factors. We evaluated the association between nativity and length of US residence, and prevalence of diabetes, hypertension, and hypercholesterolemia by select disaggregated race and ethnicity groups. Methods We conducted a pooled cross‐sectional study of 218 158 US adults from the Medical Expenditure Panel Survey (2013–2022). Nativity (US born, non‐US born) and length of US residence (≥15 years or <15 years) were used as select proxies for acculturation. Self‐reported cardiometabolic risk factors included diabetes, hypertension, and hypercholesterolemia. Results Results showed substantial heterogeneity among both aggregated and disaggregated racial and ethnic groups. Nativity (US born versus non‐US born) was significantly associated with increased hypertension prevalence among Hispanic adults (odds ratio [OR], 1.26 [95% CI, 1.15–1.39]), whereas among detailed categories the OR varied from 0.68 (95% CI, 0.51–0.93) among Puerto Rican adults to 1.34 (95% CI, 1.18–1.52) among Mexican adults. For the association between length of US residence and hypercholesterolemia, the OR for all Non‐Hispanic Asian adults was 1.18 (95% CI, 0.92–1.51), whereas results varied in detailed categories from 1.00 (95% CI, 0.64–1.57) among Indian adults to 1.69 (95% CI, 1.08–2.64) among Chinese adults. Conclusion The association between US nativity or length of US residence and cardiometabolic risk factors varies by disaggregated race and ethnicity among Hispanic and Non‐Hispanic Asian adults. Future studies may evaluate comprehensive measures of acculturation and assess other race and ethnicity groups to inform tailored efforts to improve cardiometabolic risk factor prevention and treatment.

Kidney diseases are an important public health problem, rising in global significance. In place for nearly 2 decades, the Centers for Disease Control and Prevention's Kidney Disease Surveillance System is the first comprehensive surveillance system developed in the United States, focused exclusively on tracking kidney disease before ESKD. The Kidney Disease Surveillance System incorporates key data and trends from multiple, large national-level survey data sources (National Health and Nutrition Examination Survey), electronic medical record data (Military and Veterans Affairs Health Systems), health care claims (Medicare, Optum), and social determinants of health (American Community Survey). The prevalence of CKD among civilian US adults remains steady between 13% and 14%. The prevalence is higher among older, female, non-Hispanic Black adults and those with diabetes or hypertension. Among US veterans, the incidence of CKD and rates of diagnosis of AKI increased from 2008 to 2022 (incidence: 62.8 to 71.5/1000 person-years, AKI: 84.9 to 241.7 cases/1000 person-years). Awareness of the disease nationwide among persons with CKD has historically been low (<10%), but starting in 2013, has increased to approximately 25%. Persons with CKD self-report more problems with sleep, and those aged 65 years and older self-report a higher prevalence of functional limitations. Improvements in quality-of-care measures, including medication prescription and increase in both serum creatinine and albuminuria testing were observed. Increased self-reported physical activity was observed among persons with CKD. Food insecurity increased among persons with CKD, with the highest prevalence in young, female, non-Hispanic Black, and Hispanic adults. Although population-level prevalence of CKD remains stable, higher AKI and CKD rates are being observed in health systems settings. This project's website can be found at https://wwwn.cdc.gov/KDSS/ . Robust surveillance is key to raising awareness of kidney disease, its risk factors, care quality, and outcomes. Surveillance findings may inform policy and evidence-based practices that reduce premature morbidity and mortality, improve quality of life, and reduce cost.

Ulcerative colitis (UC) prevalence is rising globally, yet fewer than 50% of patients achieve mucosal healing (MH) with first-line 5-aminosalicylic acid (5-ASA) therapy. We aimed to identify microbial signatures that could predict the treatment efficacy of 5-ASA. Active UC patients on standardized 5-ASA treatment were prospectively enrolled. Shotgun metagenomic sequencing was performed to identify the taxonomic and functional profiles before and after treatment. Six species were enriched in the effective group and 3 species in the ineffective group at baseline. Faecalibacterium prausnitzii, Blautia massiliensis, and Phascolarctobacterium faecium were consistently depleted in the ineffective group at both time points. A random forest model based on these three species predicted ineffective 5-ASA treatment with area under the curve (AUC) = 0.80 (validation in the Inflammatory Bowel Disease Multi'omics Database [IBDMDB]: AUC = 0.82, specificity = 0.88, negative predictive value [NPV] = 0.70, and positive predictive value [PPV] = 0.80). Gut microbiome signatures have potential to serve as non-invasive predictors for ineffective 5-ASA treatment in UC.

Rationale & Objective:Acute kidney injury (AKI) is a frequent complication of cancer due to multiple factors. Our aim was to assess contemporary associations between various cancers and incident AKI among Medicare beneficiaries. Study Design:A retrospective observational study. Setting & Participants:Medicare fee-for-service beneficiaries aged ≥66 years. Exposure:New cancer diagnosis. Outcomes:Incidence of AKI. Analytical Approach:Follow-up started at cancer diagnosis or on December 31, 2014, for controls and ended at the date of AKI, death, cancer in the control group, or at 5 years, whichever occurred first. Overall and site-specific associations between cancer and AKI were assessed by cause-specific Cox models and Fine-Gray competing risk models, adjusting for age, sex, race and ethnicity, and comorbid conditions. Results:We identified 482,016 beneficiaries with newly diagnosed cancer and the same number of matched controls. The median follow-up time was 4.1 years (interquartile range [IQR], 1.0-5.0 years) and 4.8 (IQR, 1.7-5.0 years), respectively, for cancer cases and controls. The highest 5-year risk of AKI was observed in cancer of the renal pelvis and ureter 32.8% (95% confidence interval [CI], 30.7%-34.8%); multiple myeloma 32.6% (95% CI, 31.7%-33.4%); and kidney cancer 28.9% (95% CI, 28.2%-29.5%). The multivariable-adjusted subdistribution hazard ratio for AKI was significantly higher for multiple myeloma compared with controls and was significantly lower for cancers with high mortality, such as pancreatic, lung and bronchial, liver, gallbladder and biliary, or stomach cancer. Limitations:Potential misclassification from using International Classification of Diseases codes to identify cancer and AKI, residual confounding from unmeasured variables, lack of information on cancer stage and histology, and not accounting for cancer treatment including medication. Conclusions:Risks of AKI vary across cancer types. Multiple myeloma had the highest significant risk of AKI compared with controls.

Background:A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system. Methods:Type 1 diabetes was identified through the Providence health system electronic health records during 2013-2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR < 45 mL/min/1.73 m2, dialysis, or transplant). Findings:The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26-1.47); age 60-79 years (reference 12-17 years; 2.22 [1.83-2.69]); Asian (reference White; 1.71 [1.20-2.44]), Black or African American (1.76 [1.45-2.14]), and Other race (1.33 [1.04-1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23-3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28-5.38]) populations. Interpretation:CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes. Funding:This work was supported in part by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264, and in part by Brigham Research Institute.

BACKGROUND:Incidence data on pediatric chronic kidney disease (CKD) is incomplete. We developed electronic health record (EHR)-based algorithms (e-phenotypes) to identify cases and provide incidence estimates of 5 leading causes of pediatric CKD. METHODS:E-Phenotypes using common standardized clinical terminology were built and contained utilization, diagnostic, procedural, age, and time-period inclusion and exclusion criteria for autosomal dominant polycystic kidney disease (ADPKD), Alport Syndrome (AS), congenital anomalies of the kidney and urinary tract (CAKUT), lupus nephritis (LN), and primary childhood nephrotic syndrome (NS). Cases diagnosed between 2014 and 2023 were identified from a pediatric healthcare system that is the sole pediatric nephrology provider serving the Atlanta Metropolitan Statistical Area (MSA). The performance of the e-phenotypes was tested using a cohort of 1,000 pediatric patients. Cases identified were used to estimate incidences using population information from the Georgia Department of Health. RESULTS:The e-phenotypes demonstrated sensitivity ranging from 0.83 to 0.95, specificity 0.96 to 1.00, PPV 0.81 to 1.00, and NPV 0.98 to 1.00. All positive likelihood ratios (LR) were >20 and negative LR < 0.20. The 6,814 combined cases of ADPKD (n=107), AS (n=31), CAKUT (n=6,120), LN (n=161), and NS (n=395) had an annual incidence of 47.07 (95% CI 45.96-48.20) per 100,000 children. Annual incidence per 100,000 children (95% CI) for each condition was: ADPKD 0.74 (0.61- 0.89), AS 0.21 (0.15-0.30), CAKUT 42.28 (41.22-43.35), LN 1.11 (0.95-1.30), and NS 2.73 (2.47-3.01). CONCLUSIONS:Our incidence estimates suggest CKD conditions are common among children. The e-phenotypes require validation for use at other institutions but offer opportunities to examine determinants of CKD detection, management, and outcomes.

Incidence data on pediatric chronic kidney disease (CKD) is incomplete. We developed electronic health record (EHR)-based algorithms (e-phenotypes) to identify cases and provide incidence estimates of 5 leading causes of pediatric CKD. E-Phenotypes using common standardized clinical terminology were built and contained utilization, diagnostic, procedural, age, and time-period inclusion and exclusion criteria for autosomal dominant polycystic kidney disease (ADPKD), Alport Syndrome (AS), congenital anomalies of the kidney and urinary tract (CAKUT), lupus nephritis (LN), and primary childhood nephrotic syndrome (NS). Cases diagnosed between 2014 and 2023 were identified from a pediatric healthcare system that is the sole pediatric nephrology provider serving the Atlanta Metropolitan Statistical Area (MSA). The performance of the e-phenotypes was tested using a cohort of 1,000 pediatric patients. Cases identified were used to estimate incidences using population information from the Georgia Department of Health. The e-phenotypes demonstrated sensitivity ranging from 0.83 to 0.95, specificity 0.96 to 1.00, PPV 0.81 to 1.00, and NPV 0.98 to 1.00. All positive likelihood ratios (LR) were >20 and negative LR < 0.20. The 6,814 combined cases of ADPKD (n=107), AS (n=31), CAKUT (n=6,120), LN (n=161), and NS (n=395) had an annual incidence of 47.07 (95% CI 45.96-48.20) per 100,000 children. Annual incidence per 100,000 children (95% CI) for each condition was: ADPKD 0.74 (0.61- 0.89), AS 0.21 (0.15-0.30), CAKUT 42.28 (41.22-43.35), LN 1.11 (0.95-1.30), and NS 2.73 (2.47-3.01). Our incidence estimates suggest CKD conditions are common among children. The e-phenotypes require validation for use at other institutions but offer opportunities to examine determinants of CKD detection, management, and outcomes.

ABSTRACTBackgroundSimilar worsening epidemics globally have been showed in newly coined metabolic dysfunction‐associated steatotic liver disease (MASLD) and inflammatory bowel disease (IBD). We aimed to investigate the prospective association of MASLD, MASLD types, and cardiometabolic risk factors (CMRFs) with long‐term risk of incident IBD in a large‐scale population cohort.MethodsParticipants free of IBD at enrollment from UK Biobank were included. Baseline MASLD was measured by fatty liver index together with at least one CMRF, based on the latest AASLD/EASL criteria. MASLD type was classified as pure MASLD and MetALD (MASLD with increased alcohol intake). Primary outcome was incident IBD, including ulcerative colitis (UC) and Crohn's disease (CD). Multivariable Cox regression was conducted to examine the related associations.ResultsOverall, 403 520 participants (aged 56.2 ± 8.1 years, 45.6% males) were included. Of whom, 151 578 (37.6%) were considered as MASLD at baseline. During a median of 13.0 years' follow‐up, 2398 IBD cases were identified. Compared with normal population, individuals with MASLD showed significant higher associations of incident IBD (HR = 1.39, 95% CI: 1.21–1.60), UC (HR = 1.34, 95% CI: 1.13–1.58), and CD (HR = 1.51, 95% CI: 1.20–1.89). Meanwhile, results were consistent when assessing pure MASLD (HR = 1.43, 95% CI: 1.23–1.66) and MetALD (HR = 1.46, 95% CI: 1.15–1.86). The excess risk of incident IBD was more evident with the increase of CMRFs numbers (ptrend < 0.001).ConclusionMASLD, either pure MASLD or MetALD, and a combination of different CMRFs are all associated with increased risk of IBD, including both UC and CD. Additionally, there is greater risk of incident IBD as the number of CMRFs increase.

Kidney diseases are an important public health problem, rising in global significance. In place for nearly 2 decades, the Centers for Disease Control and Prevention's Kidney Disease Surveillance System is the first comprehensive surveillance system developed in the United States, focused exclusively on tracking kidney disease before ESKD. The Kidney Disease Surveillance System incorporates key data and trends from multiple, large national-level survey data sources (National Health and Nutrition Examination Survey), electronic medical record data (Military and Veterans Affairs Health Systems), health care claims (Medicare, Optum), and social determinants of health (American Community Survey). The prevalence of CKD among civilian US adults remains steady between 13% and 14%. The prevalence is higher among older, female, non-Hispanic Black adults and those with diabetes or hypertension. Among US veterans, the incidence of CKD and rates of diagnosis of AKI increased from 2008 to 2022 (incidence: 62.8 to 71.5/1000 person-years, AKI: 84.9 to 241.7 cases/1000 person-years). Awareness of the disease nationwide among persons with CKD has historically been low (<10%), but starting in 2013, has increased to approximately 25%. Persons with CKD self-report more problems with sleep, and those aged 65 years and older self-report a higher prevalence of functional limitations. Improvements in quality-of-care measures, including medication prescription and increase in both serum creatinine and albuminuria testing were observed. Increased self-reported physical activity was observed among persons with CKD. Food insecurity increased among persons with CKD, with the highest prevalence in young, female, non-Hispanic Black, and Hispanic adults. Although population-level prevalence of CKD remains stable, higher AKI and CKD rates are being observed in health systems settings. This project's website can be found at https://wwwn.cdc.gov/KDSS/. Robust surveillance is key to raising awareness of kidney disease, its risk factors, care quality, and outcomes. Surveillance findings may inform policy and evidence-based practices that reduce premature morbidity and mortality, improve quality of life, and reduce cost.

We analyzed 2021 and 2022 National Health Interview Survey data to describe the prevalence of past 12-month telemedicine use among US adults with no prediabetes or diabetes diagnosis, diagnosed prediabetes, and diagnosed diabetes. In 2021 and 2022, telemedicine use prevalence was 34.1% and 28.2% among adults without diagnosed diabetes or prediabetes, 47.6% and 37.6% among adults with prediabetes, and 52.8% and 39.4% among adults with diabetes, respectively. Differences in telemedicine use were identified by region, urbanicity, insurance status, and education among adults with prediabetes or diabetes. Findings suggest that telemedicine use can be improved among select populations with prediabetes or diabetes.

Background: Caffeine is believed to possess anti-inflammatory properties, yet direct population -based evidence regarding its impact on inflammatory bowel disease (IBD) remains scarce. Objectives: In this study, we used 2 -sample Mendelian randomization (MR) study to investigate the causal relationship between long-term plasma caffeine concentrations and IBD and its subtypes, ulcerative colitis (UC) and Crohn disease (CD). Methods: We used single nucleotide polymorphisms (SNPs) associated with plasma caffeine concentrations at genome-wide significance within a +/- 100 -kb range around the CYP1A2 or AHR genes as instrumental variables. Genome-wide association study (GWAS) data for IBD and its subtypes were obtained from FinnGen and International Inflammatory Bowel Disease Genetics Consortium. We conducted a meta -analysis of MR -related SNPs from both sources and used a multiplicative inverse variance-weighted random effects model to combine the effects of each SNP proxy on exposure to outcomes. Results: In our study, genetically predicted higher plasma caffeine concentrations were associated with a lower risk of IBD, with an odds ratio (OR) of 0.78 (95% confidence interval [CI]: 0.66, 0.91; PFDR = 0.004). This trend was also observed in UC and CD, with ORs of 0.79 (95% CI: 0.66, 0.94; PFDR = 0.014) and 0.78 (95% CI: 0.62, 0.98; PFDR = 0.032), respectively. Conclusion: Our study indicates a potential causal link between genetically predicted higher plasma caffeine concentrations and a reduced risk of IBD, including its subtypes UC and CD.

Aims This study aims to describe pain management technique usage and social functioning limitations among adults with chronic pain by diabetes status. Methods The 2019 and 2020 National Health Interview Survey data were pooled to complete this analysis. Use of the following techniques in the past 3 months were measured: 1) prescription opioids; 2) physical, rehabilitative, or occupational therapy; 3) talk therapies; 4) chiropractic care; 5) yoga, Tai Chi, or Qi Gong; 6) massage; and 7) relaxation techniques. The social functioning limitations assessed were: 1) doing errands alone; 2) participating in social activities; and 3) work limitations. Weighted prevalence and 95 % confidence intervals (CIs) were estimated for each outcome by diabetes status. Logistic regression was used to estimate age- and sex-adjusted odds ratios (aORs) to assess differences by diabetes status. Results Adults with diabetes and chronic pain were more likely to use prescription opioids (aOR: 1.4; 95 % CI: 1.2, 1.6) but less likely to use various nonpharmacological techniques than those without diabetes. Additionally, adults with diabetes and chronic pain were more likely to report each social functioning limitation than those without diabetes. Conclusions Results suggest adults with diabetes and chronic pain may be missing beneficial opportunities to manage pain.

Introduction:Previous research suggests that rural-urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region. Methods:We used data from the 2019-2022 National Health Interview Survey to compare diabetes status, socioeconomic characteristics, and weight status among adults in each census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and nonmetro). We used χ2 tests and logistic regression models to assess the association of metropolitan residence with diabetes prevalence in each region. Results:Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in nonmetro counties in the South. Compared with adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age-, sex-, and race and ethnicity-adjusted odds ratio [OR] = 1.24; 95% CI, 1.06-1.45) and South (OR = 1.15; 95% CI, 1.02-1.30). Nonmetro residence was also associated with diabetes in the South (OR = 1.62 vs large central metro; 95% CI, 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became nonsignificant, but nonmetro residence in the South remained significantly associated with diabetes (OR = 1.22; 95% CI, 1.07-1.39). Conclusion:The association of metropolitan residence with diabetes prevalence differs across US regions. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed.