The Centers for Disease Control and Prevention estimates that 29.1 million Americans today have diabetes. While diabetes is the seventh leading cause of death in the U.S., most cases of type 2 diabetes are preventable. Diabetes can be prevented by healthy eating, weight management, and an active lifestyle — factors which vary heavily by geography. An estimated 11.0% of adults in the Nashville-Davidson–Murfreesboro–Franklin metro area have diabetes, more than the national share of 9.3% yet the second smallest share in Tennessee.

According to the CDC, more than one in three Americans is prediabetic. A person with prediabetes has blood sugar levels higher than normal, and is 15% to 30% more likely to develop diabetes within five years. Prediabetes is mostly caused by lifestyle factors such as diet and exercise, as well as risk factors such as age and family history. In Nashville, some 28.4% of adults do not exercise outside of work, higher than the national share of 23.0% inactive Americans.

In inactive lifestyle can affect the likelihood of excess body fat, and a high share of inactive residents often results in a high obesity rate. In Nashville, 32.0% of residents are obese, higher than the national rate of 27.0% and the fourth highest of any Tennessee metro area.

Residents of Nashville are also more likely to engage in other unhealthy behaviors. For example, the city’s 21.3% smoking rate is higher than than the corresponding national rate of 17.0%.

Diabetes is often more prevalent in low-income areas where residents tend to have lower education levels. Individuals living in impoverished neighborhoods are less likely to have adequate access to healthy food, opportunities for exercise, or preventative health care. According to one study, residents of poor neighborhoods are up to twice as likely to have diabetes than those in wealthy neighborhoods.

In the Nashville metro area, the typical household earns $57,985 annually, roughly $2,200 more than the national median household income of $55,775. An estimated 33.6% of adults in Nashville have a bachelor’s degree, a larger share than the national college attainment rate of 30.6% and the highest of any city in Tennessee.

Diabetes increases the risk of blindness, kidney failure, heart disease, and stroke. Ultimately, the risk of death is 50% higher for adults with diabetes than those without. Diabetes causes 76,600 deaths in the U.S. annually, or roughly 24 per 100,000 Americans. Overall, an estimated 474 in 100,000 Americans die prematurely before the age of 75 each year. In the Nashville metro area, there are 388 deaths per 100,000 metro area residents, more than the national mortality rate and the lowest of any city in Tennessee.

Parts of the Nashville-Davidson–Murfreesboro–Franklin metro area are located within the region the CDC identified as the diabetes belt, a span of 644 counties in the southern U.S. where type 2 diabetes is particularly common.