Diabetes is undiagnosed in nearly 28 percent of Americans who have the disease, reports a new study published in CMAJ Open.
This finding has significant implications for public health, the quality of health care — and maybe for you or someone you love.
“Undiagnosed diabetes is an important problem because the condition develops insidiously and, in the early phase, symptoms are often rather vague and non-specific,” says lead study author, Tom Holt. “So by the time the diagnosis is made, a proportion of patients have established complications that would have been preventable by earlier detection and treatment.”
In this large-scale analysis, researchers scanned 11.5 million electronic patient health records at more than 9,000 primary-care clinics across the United States. They looked at lab results that immediately identified patients as diabetic (though they had not been given that diagnosis in their record), including blood glucose (overnight fasting glucose) and a blood test called HbA1c, which reflects a person's average blood glucose levels over the past two to three months and is now commonly used to diagnose diabetes.
The analysis also showed that cases of undiagnosed diabetes were disproportionately concentrated in specific parts of the country, in particular in Arizona, Indiana, Minnesota, North Dakota and South Carolina.
In those areas, rates of undiagnosed diabetes were as high as 12 to 15.9 percent of the overall diabetes population.
When the disease goes unregistered, patients suffer. Complications from untreated diabetes can include retinopathy (eye damage) or nephropathy (kidney damage) and a raised risk of cardiovascular disease (e.g. heart attacks and strokes).
“Through failure of detection, such people may not be offered treatments that are known to effectively reduce their risk, simply because their need for them has not been recognized,” says Holt.
There is “an enormous opportunity to improve management because of all the benefits that flow from inclusion in a diabetes register,” he adds, such as targeted health interventions, screening reminders and decision-support tools.
If you’re curious about your blood sugar levels, ask your doctor about a blood glucose test and a hemoglobin A1c (HbA1c) test and be sure to discuss the findings with him or her.