Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

36% of Patients with Diabetes are Undiagnosed, Unmanaged

By Jennifer Bresnick

- More than a third of American patients with diabetes are unaware that they are living with the chronic disease, says new research published this month in the Journal of the American Medical Association (JAMA).  The worrying statistic, drawn from 2011 and 2012 National Health and Nutrition Examination Survey data, highlights the significant opportunities for improvement in the healthcare industry’s population health management, risk identification, and chronic disease management strategies.

Diabetes and population health management

Diabetes is one of the most common – and most expensive – chronic diseases in the United States, incurring approximately $245 billion in lost productivity and healthcare service expenditures in 2012, write researchers from the National Institutes of Health, the CDC, and Social & Scientific Systems Inc. 

More than 14 percent of the population is suffering from diabetes or pre-diabetes, the study found, when nearly 2800 patients were classified using a hemoglobin A1C level of 6.5 percent or greater, or a fasting plasma glucose (FPG) level of 126 mg/dL or greater. 

“In the overall population, the unadjusted prevalence was 14.3 percent for total diabetes, 9.1 percent for diagnosed diabetes, 5.2 percent for undiagnosed diabetes, and 38.0 percent for prediabetes,” the authors write. Diabetes rates have increased steadily across all ethnic, gender, and age groups since the late 1980s, with the highest prevalence among black, Asian, and Hispanic patients.

The data is similar to a 2014 study by the Centers for Disease Control, which found that 28 percent of the 9.3 percent of Americans living with diabetes were unaware of their condition.  The CDC study also used patient data from 2012.  Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation, called the statistics “alarming.” 

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“It’s urgent that we take swift action to effectively treat and prevent this serious disease,” Albright said.  Diabetes was the seventh leading cause of death in 2010, but the CDC noted that the disease may have a much wider impact on mortality rates than reported. 

Diabetes is not often listed as a direct or underlying cause of death, yet the disease is often directly implicated in the occurrence of heart attacks and strokes, which are more frequently recorded as the cause of death in medical records.

The JAMA study found that Medicare-aged patients were more likely than younger patients to suffer from diabetes – the unadjusted prevalence of total diabetes was 33 percent in patients aged 65 or older, compared to 17.5 percent in those aged 45 to 64, and 5 percent in patients younger than 45. 

Non-white patients were also more likely to develop the chronic disease.  While the age-standardized rate of diabetes in white patients hovered around 11 percent, other ethnic groups experienced nearly double the prevalence.  

Non-Hispanic black patients (21.8 percent), Asian patients (20.6 percent) and Hispanic patients (22.6 percent) were significantly more likely to develop the disease.  Black and Hispanic patients also exhibited higher mean body mass index (BMI) scores than white or Asian participants.

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Hispanic and Asian patients are among the most likely to be living with diabetes but not know it, the study found.  While the rate of undiagnosed diabetes has actually dipped slightly in the past few years, the authors attribute the change to more frequent diagnosis, not a slowdown in diabetes development.  Over fifty percent of Asian patients and 49 percent of Hispanic patients were undiagnosed.

“In all, 10.6% of non-Hispanic Asian participants were estimated to have had undiagnosed diabetes, which was higher than any other racial/ethnic group,” the authors write. “This may partly be due to less frequent screening for diabetes because non-Hispanic Asian individuals on average have lower BMIs.” 

The study notes that the World Health Organization has suggested using different BMI criteria for diabetes screenings for patients of Asian descent in order to provide more sensitive risk evaluation for these populations.

The prevalence of prediabetes is also of concern, the study continues, with 37 to 38 percent of the overall population affected by the condition, also known as metabolic syndrome.  Prediabetes was most common among non-Hispanic black participants, at 39.6 percent.  When added to the percentages of patients with fully developed diabetes, more than half of the United States population is affected by the condition to some degree.

The data indicates that healthcare providers must do more to provide diabetes screenings and robust chronic disease management programs to their patients, no matter what the ethnic or age profile of their attributed populations. 

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As accountable care and value-based reimbursement demand that primary care providers shoulder more financial and clinical responsibility for their patients in the long-term, bolstering screening initiatives and implementing more comprehensive population health management strategies may help to lower the rates of undiagnosed diabetics while delivering necessary chronic disease management to those who are more aware of their health status.


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