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09-18-2018 | Diagnosis | News

Type 2 diabetes undiagnosed in a third of people with known hyperglycemia

medwireNews: A large proportion of people with documented hyperglycemia are still not clinically diagnosed with type 2 diabetes for up to 1 year later, US study data show.

Anjali Gopalan and colleagues, from Kaiser Permanente Northern California in Oakland and Santa Clara, USA, found that 30.2% of 18,356 adults from their institution who first had an elevated glycated hemoglobin (HbA1c) level (≥48 mmol/mol; ≥6.5%) between 2014 and 2015 remained undiagnosed with type 2 diabetes 1 year later.

The findings raise questions regarding the use of electronic health records (EHRs), Gopalan and co-authors remark in Diabetes Care.

They say: “Although EHRs provide easy access to available HbA1c data, this may not be sufficient to trigger the documentation and subsequent care processes for people with newly diagnosed Type 2 diabetes.”

The team adds: “Ensuring timely Type 2 diabetes diagnoses may require EHR advances that more explicitly and automatically connect available test results to diabetes diagnoses and prompt early intervention towards the goal of improved Type 2 diabetes outcomes.”

The researchers report that individuals with lower mean index HbA1c values (48–<53 mmol/mol; 6.5–<7.0%) were a significant 5.95 times more likely to remain undiagnosed than those with higher index HbA1c (53–<64 mmol/mol; 7.0–<8.0%).

People aged 70 years and older were a significant 1.40 times more likely to remain undiagnosed than those aged 50–59 years, while the likelihood was 1.35-fold higher for people with prediabetes than for those without, and 1.26-fold higher for Black versus White individuals.

Gopalan et al say there could be several reasons for the delayed diagnoses, including the fact that “providers may not formally document a diagnosis unless they are initiating pharmacological treatment, because ordering a prescription medication requires an associated ICD-9/10 code.”

Since people with lower index HbA1c values may be less likely to be prescribed medications, they would also be less likely to have a documented diagnosis, the researchers note.

They add: “This documentation practice may also explain the observed associations between undiagnosed diabetes with older age and prior prediabetes diagnoses. Given the less-stringent HbA1c targets recommended for older adults, providers may be less likely to start pharmacological treatment and, therefore, would be less likely to document a new clinical diagnosis.”

The team also found that, after adjustment for age, index HbA1c, and race/ethnicity, undiagnosed people were significantly less likely to receive diabetes-related education (adjusted odds ratio [aOR]=0.08), a retinal examination (aOR=0.02), and treatment with metformin (aOR=0.06).

Although these findings were expected, they “help to quantify the early intervention opportunities that may be missed when diagnoses are delayed,” say the researchers.

They conclude: “Regardless of formal Type 2 diabetes diagnosis status, all the examined individuals arguably have some level of impaired glucose tolerance and could benefit from health education and the initiation of metformin therapy.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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