Type 2 diabetes is a lifelong condition that stems from a problem with the way the body regulates and uses sugar as fuel. The disease can affect many major organs, including the heart, blood vessels, nerves, eyes and kidneys. 

Rates of diabetes have increased among the overall population in the United States since the start of Covid-19, and, according to Shauna Stahlman, an epidemiologist at the Armed Forces Health Surveillance Division, the U.S. military is no exception. 

Stahlman and other researchers with the Military Health System tracked an increase in Type 2 diabetes (T2D) among active-duty service members from 2018 to 2021, along with spikes in obesity rates during those same years. A diagnosis can limit troops’ abilities to perform certain duties and is a disqualifying factor to join the armed forces. Therefore, increases of T2D among young people in the U.S. is shrinking the pool of potential military recruits.

“Service members are unique in that they are deployed to austere environments that demand high physical performance,” Stahlman said. “Having a chronic disease such as diabetes may not allow members to perform at their peak and could put them and the mission at risk.”

The Military Health System published a study in 2023 that found increases over the past several years in obesity, prediabetes and Type 2 diabetes. In 2018, about 56 out of every 100,000 service members had Type 2 diabetes. By 2021, that number had climbed to almost 70 out of every 100,000 service members.

The diagnosis rates have continued to increase in subsequent years. Data for 2022 and preliminary data for 2023 show that the cases of diabetes in the active-duty force is “remaining elevated,” Stahlman said.

“There’s no suggestion that the diabetes prevalence is going down,” she said.

Rates of diagnoses jumped by about 48% among Hispanic service members from 2018 to 2021, the most of any demographic. Among the entire U.S. population, Hispanics have higher rates of diabetes among children and adults, and they have the highest lifetime risk of Type 2 diabetes, according to research published in Diabetes Metabolism Research and Reviews.

“Demographic trends in the military are very similar to what’s observed in the U.S. population,” Stahlman said. “Though service members are generally healthier due to the nature of their work and physical fitness requirements, they’re not completely isolated, and we tend to see the same sort of patterns in them as we do the population overall.” 

The rates of increased diagnoses were slightly higher among women in the military than men, with a 26% increase in rates for men from 2018 to 2021 and 27% increase for women, the research shows. 

Active-duty men and women saw similar increases of prediabetes during those years, with both experiencing a 29% jump in rates. Prediabetes shows up as high blood-sugar levels, but not high enough to be considered Type 2 diabetes. Without lifestyle changes, people with prediabetes are at high risk of developing diabetes. 

Members of the U.S. Navy experienced the largest increases in diabetes diagnoses from 2018 to 2021 compared to members of other branches of the Armed Forces, the Military Health System research found. The Air Force saw the second-largest jump, followed by the Army, and last, the Marine Corps. Researchers attributed the varying increases in rates to the differences in troops’ environments. 

“Sailors underway on ships and submarines face highly restricted environments with limited food choices, as well as restricted time and space to perform physical training,” the research shows.

Spikes in diabetes and prediabetes diagnoses in 2020 and 2021 were likely the result of a substantial rise in obesity rates during a time when service members were more sedentary and experiencing prolonged quarantine periods. And obesity increases the risk of diabetes.

Researchers reviewed data from service members who completed a Periodic Health Assessment, a test that evaluates a troops’ medical readiness. In 2018, 16.1% of service members who took the assessment were living with obesity. That amount jumped to 18.8% in 2021. 

The increase in obesity was greater among women, who experienced a 29% increase, compared to 15% among men. Military healthcare workers saw the biggest rise in obesity from 2018 to 2021 out of all other military occupations.

At the start of the Covid-19 pandemic, gyms closed down and people across the world experienced more stress and were forced out of their normal routines. The drastic changes led to an increase in risk factors for chronic diseases, including diabetes, Stahlman said. 

Diabetes and military service

Though a diabetes diagnosis can disqualify someone from joining the military, those troops diagnosed while serving often remain in the military. However, depending on their jobs, their duties can be limited.

When service members are diagnosed with diabetes, they must undergo an assessment by a Medical Evaluation Board, which determines whether they meet medical standards to continue in their roles. Having to use insulin for treatment is one reason troops with diabetes may be prevented from deploying to locations where they wouldn’t have access to healthcare or the ability to keep their insulin at the proper temperature. 

“Having a condition such as diabetes doesn’t necessarily stop a member from continuing service. There are factors that affect the decision,” Stahlman said. “Medical evaluators have to consider things like the severity of their condition, their duty assignment and medical services available in theater when deciding whether a member with diabetes is deployable.”

To combat the increasing rates of Type 2 diabetes among troops, the military is centering lifestyle and performance medicine, which puts more focus on preventing diabetes, rather than only treating the condition among service members who have already been diagnosed, Stahlman said. The concept emphasizes the importance of nutrition, physical activity, sleep, stress management and creating more social connections. And a growing number of military clinics are embracing the strategy.

“I am a believer in the need for these strategies to address the root cause of the problem,” Stahlman said. “The growing popularity of lifestyle medicine is a good thing, and the emphasis should continue to be on enhancing the wellness and general readiness of our service members.”

This educational resource was created with support from AstraZeneca.