Assessing Diabetes Variations Across Major Metropolitan Cities in the state of Texas, United States of America from 2011-2023

Background: Diabetes among adults is becoming a major public health crisis in the United States. Numerous authors have documented the rising prevalence of diabetes, with notable variations found within the United States at the census level, state, and county levels. Yet, there is a need to understand whether diabetes prevalence varies between urban centers within a particular state. Methods: This ecological study provides a longitudinal investigation of the prevalence of adult diabetes across five major metropolitan urban areas in Texas (Austin, Dallas, Fort Worth, Houston, and San Antonio) from 2011 to 2023. By utilizing data from the Behavioral Risk Factor Surveillance System (BRFSS) and statistical testing, we evaluate both the temporal trajectory and city-level geographic disparities of diabetes prevalence. Findings: Upon aggregating all five urban centers, the findings demonstrate a significant statewide increase (β=0.12, P=0.026) in diabetes prevalence over the thirteen-year study period. Furthermore, profound regional variations were observed, with San Antonio having a significantly (P