When Michael Bass learned five years ago that his blood sugar levels were dangerously high, the 72-year-old made a choice that changed his life. His doctor recommended medication for Type 2 diabetes after testing his A1C, a measure of average blood sugar over several months. But Bass wasn’t ready to rely on prescriptions.
“I wanted to take control of my health,” Bass said. “It helped — taking all-natural supplements, exercising and eating better.”
Through consistent exercise and diet changes, Bass lowered his A1C to 6.1 and maintained that range for three years. The results gave him a sense of empowerment and accomplishment.
Bass’s story is a familiar one in Missouri, where diabetes affects hundreds of thousands of adults and disproportionately impacts Black residents. Health officials say it is one of the most manageable chronic conditions, yet also among the most expensive and widespread in the state.
According to the 2025 Missouri Diabetes Report, nearly 600,000 adults — about 12.3% of Missouri’s adult population — have been diagnosed with diabetes, up from 11.2% just two years ago.
Like many, Bass found that a diet change and added exercise routine can become difficult to maintain over time. His new lifestyle reverted back to old habits. After a few years, he admits he “fell off the wagon.” His eating habits worsened, he exercised less and a trip to urgent care revealed his blood sugar had spiked again.
Now, he takes Jardiance and Trulicity daily to keep his levels stable. Still, he hasn’t given up on his goal of managing diabetes without medication.
“Our community doesn’t shop the outside aisles of the grocery store,” Bass said. “That’s where the healthier options are.”
He believes diet plays a major role in the high diabetes rates among communities of color.
He’s not alone in his determination. Gladys Manuel, 60, has lived with diabetes for 25 years. Diagnosed at age 35 as prediabetic, she followed her doctor’s advice and began medication early. With a focus on balance, she has kept her A1C between 6.0 and 6.7 for decades.
“I watch what I eat and try to live a stress-free life,” Manuel said. “When I have a cheat day, I enjoy sweets — but in moderation.”
Diabetes runs in her family — her mother and two sisters also live with the condition. Manuel says the key is consistency and self-care.
“Stay on top of it early,” she said. “Exercise, eat better and don’t ignore the warning signs.”
Across Missouri, stories like theirs are common. The Missouri Diabetes Report from 2023 shows nearly 600,000 Missouri adults — or 12.3% of the adult population — have been diagnosed with diabetes, up from 11.2% in 2021.
The state report also shows adults living in households earning $25,000 or less are 2.5 times more likely to have diabetes than those with higher incomes. Education also plays a role: individuals without a high school diploma face nearly double the risk compared to those with more education.
The disparities are even more striking among Black residents. Hospitalization and death rates related to diabetes are more than twice as high among Black Missourians as among White Missourians.
In St. Louis, the Department of Health reported that in 2018, the diabetes death rate among Black residents was 26.8 per 100,000, compared to 21.0 per 100,000 for White residents. The city also faces high obesity rates and limited access to healthy foods. About 15% of adults lack health insurance, increasing the risk of complications and reducing access to treatment.
BJC HealthCare reports that Black people are 60% more likely to be diagnosed with diabetes and 30% more likely to die from heart disease than White adults. Health experts warn that those numbers could rise sharply by 2060 without stronger preventive measures.
State programs are working to address those gaps. Missouri launched the Primary Care Health Home Program in 2012 through the Department of Social Services and the MO HealthNet Division. The program now serves more than 40,000 residents statewide, with 34% of participants diagnosed with diabetes and more than half classified as obese.
The initiative focuses on addressing social determinants of health — including access to nutritious food, housing and education — that shape overall well-being.
Still, both Bass and Manuel believe lifestyle changes can make a difference. They say the first step is understanding that diabetes doesn’t have to define one’s life.
“Exercise and eating right make all the difference,” Bass said. Manuel agreed, adding, “Take care of yourself early. It’s about making better choices every day.”