Diabetes risk factors fall into two categories: those you can change and those you cannot. According to the Centers for Disease Control and Prevention, more than 38 million Americans have diabetes and 98 million have prediabetes — most of them undiagnosed. Understanding your risk factors is the first step toward prevention.
Modifiable vs. Non-Modifiable Risk Factors
Some diabetes risk factors are within your control, while others are not. Knowing the difference matters because it shapes your prevention strategy — you focus on changing what you can while monitoring what you cannot.
| Modifiable (You Can Change) | Non-Modifiable (You Cannot Change) |
|---|---|
| Weight and body composition | Age |
| Physical activity level | Family history |
| Diet quality | Race and ethnicity |
| Sleep habits | History of gestational diabetes |
| Stress management | PCOS diagnosis |
| Smoking | Genetic predisposition |
Modifiable Risk Factors
Weight and Body Composition
Being overweight is the strongest modifiable risk factor for type 2 diabetes. Excess body fat — especially visceral fat stored around the abdomen — increases insulin resistance, making it harder for your body to regulate blood sugar. A waist circumference greater than 40 inches in men or 35 inches in women is a warning sign, even if your overall BMI is not extremely high.
The good news: even modest weight loss makes a big difference. The Diabetes Prevention Program showed that losing just 5-7% of body weight reduced diabetes risk by 58%. For a 200-pound person, that is 10-14 pounds.
Physical Inactivity
A sedentary lifestyle is an independent risk factor for diabetes. Regular physical activity improves insulin sensitivity, helps control weight, and directly lowers blood sugar. According to the ADA, adults should aim for at least 150 minutes per week of moderate-intensity exercise like brisk walking.
Sitting for extended periods is harmful even if you exercise regularly. Try to break up long sitting stretches with short walks or standing breaks every 30-60 minutes.
Diet
Diets high in refined carbohydrates, added sugars, and processed foods increase diabetes risk. Sugary beverages are particularly problematic — drinking one or more servings per day has been associated with a 26% increased risk of type 2 diabetes. Conversely, diets rich in fiber, whole grains, vegetables, and lean proteins are protective. See our diet and nutrition hub for specific guidance.
Sleep
Both too little and too much sleep are linked to higher diabetes risk. Sleeping fewer than six hours or more than nine hours per night is associated with increased insulin resistance. Sleep disorders like obstructive sleep apnea further compound the risk.
Smoking
Smokers are 30-40% more likely to develop type 2 diabetes than non-smokers, according to the CDC. Nicotine increases insulin resistance, and smoking promotes abdominal fat accumulation. Quitting smoking reduces your risk over time, though it may take several years to reach the level of someone who never smoked.
Chronic Stress
Chronic stress elevates cortisol, a hormone that raises blood sugar and promotes fat storage around the midsection. Stress also drives unhealthy behaviors — emotional eating, poor sleep, skipped workouts — that further increase risk.
Non-Modifiable Risk Factors
Age
The risk of type 2 diabetes increases with age, particularly after 35. The ADA recommends that all adults begin screening at age 35. Among adults 65 and older, approximately 29% have diabetes. The age-related increase is driven by declining insulin production, reduced muscle mass, and years of accumulated metabolic stress.
Family History
Having a first-degree relative (parent, sibling, or child) with type 2 diabetes approximately doubles your risk. If both parents have diabetes, the risk increases further. Family history reflects shared genetics and, often, shared lifestyle habits — you cannot change your genes, but you can change the lifestyle part of the equation.
Race and Ethnicity
Certain racial and ethnic groups face significantly higher diabetes risk. According to the CDC, the prevalence of diagnosed diabetes is:
- American Indian/Alaska Native: 14.7%
- Non-Hispanic Black: 11.7%
- Hispanic/Latino: 12.5%
- Asian American: 9.2% (often at lower BMI thresholds)
- Non-Hispanic White: 7.5%
These disparities reflect a combination of genetic factors, socioeconomic differences, access to healthcare, and environmental exposures. If you belong to a higher-risk group, earlier and more frequent screening is important.
Gestational Diabetes History
Women who had gestational diabetes during pregnancy have a 50% higher risk of developing type 2 diabetes within 5-10 years after delivery. If you had gestational diabetes, the ADA recommends getting tested for diabetes every one to three years for life.
Polycystic Ovary Syndrome (PCOS)
PCOS is closely linked to insulin resistance and affects about 6-12% of women of reproductive age. Women with PCOS have a significantly higher risk of developing prediabetes and type 2 diabetes, even at a young age. Regular screening and proactive lifestyle management are important for women with this condition.
Risk Assessment: How Many Risk Factors Do You Have?
Risk factors do not operate in isolation — they compound. Having multiple risk factors significantly increases your overall likelihood of developing prediabetes or diabetes. Use this table to assess your personal risk profile:
| Risk Factor | Check If It Applies | Risk Impact |
|---|---|---|
| Overweight or obese (BMI 25+) | Yes / No | High |
| Age 35 or older | Yes / No | Moderate |
| Parent or sibling with type 2 diabetes | Yes / No | High |
| African American, Hispanic, Native American, or Asian descent | Yes / No | Moderate to High |
| Physically inactive (less than 150 min/week exercise) | Yes / No | Moderate |
| History of gestational diabetes | Yes / No | High |
| PCOS diagnosis | Yes / No | Moderate to High |
| High blood pressure (140/90 or higher) | Yes / No | Moderate |
| Low HDL cholesterol or high triglycerides | Yes / No | Moderate |
| Sleep fewer than 6 hours per night | Yes / No | Moderate |
If you checked three or more, talk to your doctor about getting an A1C test if you have not had one recently. Early detection gives you the most time and options for prevention.
What to Do If You Have Risk Factors
Having risk factors does not mean diabetes is inevitable. For modifiable factors, evidence-based steps include losing weight if overweight, exercising at least 150 minutes per week, improving your diet, getting 7-8 hours of sleep, quitting smoking, and managing stress. For non-modifiable factors, the key actions are getting screened regularly, knowing your A1C and fasting glucose numbers, and working with your doctor on a monitoring plan.
Learn more about the specific steps you can take in our prediabetes 101 guide.
The Bottom Line
Diabetes risk factors range from things you can control — weight, diet, exercise, sleep, and smoking — to things you cannot, like age, family history, and ethnicity. The more risk factors you have, the more important it is to get screened and take preventive action. Even people with strong genetic risk can substantially lower their odds of developing diabetes through lifestyle changes. Talk to your doctor about your personal risk profile and create a screening and prevention plan.
