Pediatric diabetes specialist access varies up to 8-fold across US states

Clinical takeaway: Access to pediatric endocrinology varies substantially across the US. In areas with limited specialist availability, stronger coordination among primary care, endocrinology, telehealth, and multidisciplinary diabetes teams may become increasingly important as type 1 diabetes care grows more complex.

Children with type 1 diabetes (T1D) increasingly rely on specialized care to manage insulin therapy, diabetes technology, and emerging treatment options. But a new state-by-state analysis suggests access to that expertise depends heavily on where patients live.

Researchers estimated that nearly 197,000 Americans younger than 20 years were living with T1D in 2024. Yet the availability of board-certified pediatric endocrinologists differed dramatically across states relative to the number of children requiring care.

Pediatric endocrinologist availability varied 6- to 8-fold across states. Idaho had the lowest ratio, at 2.7 pediatric endocrinologists per 1,000 children younger than 18 years with T1D, followed by Wyoming at 3.4. Nebraska, Nevada, Mississippi, North Dakota, and New Mexico also had fewer than 5 specialists per 1,000 children with T1D.

At the other end of the spectrum, Rhode Island and Massachusetts had 22.5 and 20.7 pediatric endocrinologists per 1,000 children with T1D, respectively. Washington, DC, had an even higher concentration at 46.4 per 1,000.

The geographic variation in specialist availability was substantially greater than previously reported differences in the distribution of primary care physicians or specialists overall. T1D burden also varied by state: estimated incidence among people younger than 20 ranged from 17.0 per 100,000 in Hawaii to 27.8 per 100,000 in West Virginia.

The workforce gap could become more consequential as T1D screening identifies more people at risk, new treatments become available, and diabetes technologies advance. The findings highlight where expanded specialist capacity and multidisciplinary support may be needed to prevent geographic disparities in access to T1D care from widening.

The authors concluded that the findings demonstrate “substantial inequity in the distribution of pediatric endocrinologists,” adding that steps should be taken to address this inequity and prevent it from widening.

Source: Wang F, et al. (2026 Aug 7) JAMA Netw Open. Type 1 diabetes incidence and prevalence in the US