Only a small fraction of diabetes cases go undiagnosed

1. Undiagnosed diabetes was more common in overweight or obese adults, older adults, racial and ethnic minorities, and patients lacking health insurance.

2. The majority of U.S. adults with diabetes have received a diagnosis.

Evidence Rating Level: 2 (Good)

Study Rundown: Diabetes is one of the most common, chronic health conditions. The authors of this study sought to better understand the extent of undiagnosed diabetes in the United States, in order to make recommendations regarding evaluating and monitoring public health efforts related to diabetes screening and diagnosis. Generally, they observed that while there has been an increase in the number of undiagnosed cases of diabetes over the past 20 years, undiagnosed diabetes as a whole as decreased proportionally with respect to total diabetes cases. This study has several limitations. First, the study used fasting glucose and HbA1c levels at only one time point; the study may have benefited if these results were confirmed with a second blood sample, as the single blood level may have overestimated the prevalence of undiagnosed diabetes. Furthermore, the study may not be applicable to all subsets of the population. Overall, the results of this study suggest that undiagnosed diabetes comprises only a fraction of total cases today.

Click to read the study in the Annals of Internal Medicine

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In-Depth [retrospective cohort]: The authors conducted a cross-sectional study using results from the National Health and Nutrition Examination Survey from 1988 to 1994 and 1999 to 2014. The study included U.S. adults aged 20 years or older and relied on self-report to identify those with diabetes. Study outcomes included the number of adults with confirmed undiagnosed diabetes, which was determined as levels of fasting glucose (≥ 7.0 mmol/L) and HbA1c (≥6.5%) in patients without diagnosed diabetes. Generally, it was found that the number of undiagnosed diabetes cases have increased over the past 20 years, from 0.89% in 1988 to 1994 to 1.2% in 2011 to 2014. However, proportionally, these cases make up less of the total number of diabetes cases than in the past. By 2011 to 2014, these cases only comprised 10.9% of total diabetes cases, compared to 16.3% in 1988 to 1994. Finally, it was observed that age, sex, and race all contributed with respect to the sub-groups of patients at higher risk of undiagnosed diabetes.

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