Undiagnosed diabetes in U.S. less than half of current estimates

A new study from researchers at the Johns Hopkins Bloomberg School of Public Health estimates that the overall number of undiagnosed diabetes cases in the U.S. is significantly lower than current government estimates suggest.

The findings, published online July 11 in Diabetes Care, suggest that public health efforts to improve diabetes awareness and screening over the past three decades have translated into better detection of type 2 diabetes in the U.S. At the same time, the study showed major disparities in the burden of undiagnosed diabetes in certain population subgroups.

For their analysis, the researchers used government health survey data covering thousands of people over more than 30 years, 1988 to 2020. Instead of estimating undiagnosed diabetes from single blood test results, as the Centers for Disease Control and Prevention does, the researchers used the two-test criterion that doctors use when screening for diabetes. The researchers found that about 9.5 percent of the total diabetes burden in the U.S. is undiagnosed, versus estimates in the 20-to-30 percent range.

“Our findings suggest that the true figure is much lower and that providers in the U.S. are doing a good job overall with diabetes screening and diagnosis,” says study senior author Elizabeth Selvin, PhD, professor in the Bloomberg School’s Department of Epidemiology. “Nonetheless, undiagnosed diabetes remains high in some subgroups, indicating that there’s still a long way to go.”

The analysis found that undiagnosed diabetes is more prevalent in older and obese adults, racial/ethnic minorities, notably Mexican Americans and Asian Americans, and those without health care access. Individuals who reported an interval of more than one year since their last health care visit also had a high estimated prevalence of confirmed undiagnosed diabetes.

“It’s a real concern that certain populations are being missed by the health care system. This is likely a major reason why undiagnosed diabetes remains high in these groups,” says Michael Fang, PhD, assistant professor in the Department of Epidemiology at the Bloomberg School and the paper’s first author.

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