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01-08-2022 | Diabetes | News | Article

‘Major improvements’ in diabetes detection in USA

Author: Lynda Williams

medwireNews: The number of people with undiagnosed diabetes in the USA has fallen in the past 3 decades, indicates research published in Diabetes Care.

The proportion of diabetes cases that went undetected “sharply declined” between 1988 and 2020, “suggesting major improvements in diabetes awareness, screening and detection,” report Elizabeth Selvin, from Johns Hopkins University in Baltimore, Maryland, USA, and co-authors.

Using data from the National Health and Nutrition Examination Survey for 30,492 adults aged at least 20 years, the team determined the proportion of participants who had undiagnosed diabetes, defined as having high levels of both fasting plasma glucose (FPG; ≥126 mg/dL [6.99 mmol/L]) and glycated hemoglobin (HbA1c; ≥6.5% [48 mmol/mol]) in the absence of a physician diagnosis.

In addition, participants were classified as having persistent undiagnosed diabetes if they had elevated HbA1c or FPG after adjusting for within-person variability for these tests, the researchers explain.

Analysis showed that the prevalence of total diabetes – defined as diagnosed cases plus persistent undiagnosed diabetes – rose from 6.8% in 1988–1994 to 14.2% in 2017–2020.

This change was “driven by increasing levels of diagnosed diabetes,” the researchers say, noting that the prevalence of persistent undiagnosed diabetes was stable over the two periods, at 2.2% and 2.5%, respectively.

Thus, the proportion of all diabetes cases that were undiagnosed fell from 32.8% to 17.8% over the study period, say Selvin and co-authors.

The researchers also used the “more conservative” definition of confirmed undiagnosed diabetes, and with this analysis the total prevalence of diabetes increased from 5.7% to 12.9%. The rates of confirmed undiagnosed diabetes again remained consistent at 1.1% and 1.2%, respectively, whereas the proportion of all undiagnosed cases fell from 19.3% to 9.5%.

Analysis of data for 2011–2020 revealed that the age-adjusted rates of persistent and confirmed undiagnosed diabetes were higher among individuals aged at least 65 years (3.4 and 1.7%, respectively) versus those aged 45–65 years (2.9 and 1.7%) or 20–44 years (1.1 and 0.8%).

There was also an increased age-standardized prevalence of both persistent and confirmed undiagnosed diabetes among ethnic minorities, and adults with obesity.

In addition, the prevalence of persistent and confirmed undiagnosed diabetes was higher among adults without a healthcare visit in the past year than among those who had a recent visit.

“Among adults with diabetes, the populations with the highest proportion of cases that were undiagnosed included Asian Americans and those without health insurance, usual access to care, or a recent health care visit,” the researchers summarize.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2022; doi:10.2337/dc22-0242

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