Many May Have Undiagnosed Diabetes

Diabetes may be undiagnosed in many, but electronic record searches may identify these patients

(RxWiki News) Left untreated, diabetes can lead to a host of health problems, such as heart attack, stroke and kidney disease. The condition, however, may go undetected in many patients.

If a person’s blood sugar stays at a high level because of untreated diabetes, it can damage the heart, eyes, kidneys, nerves and other parts of the body over time. Medication and lifestyle changes like diet and exercise can keep the complications at bay.

But a new study found that many patients may not even know they have the condition. A simple electronic search of medical records, however, may easily pinpoint those who have the condition, the study authors noted.

"The consequences of letting diabetes go undiagnosed can include but are not limited to high cholesterol, high blood pressure, heart disease, kidney disease, blindness, stroke and even amputations. The key to eliminating these is early diagnosis and treatment," said Jinju Weiss, DO, of Baylor Medical Center at McKinney and Baylor Family Medicine at Aubrey.

"Doctors can improve detection of diabetes with routine screening and educating patients about the typical symptoms associated with diabetes. These symptoms include: feeling thirsty, frequent urination, feeling hungry, feeling tired, blurry vision, tingling or numbness in hands and feet," said Dr. Weiss, who was not involved in this study. "Patients must make it their priority to complete their annual physical and also seek medical help if they develop any of the above symptoms."

For this new study, Tim A. Holt, PhD, with the Nuffield Department of Primary Care Health Sciences at the University of Oxford in the United Kingdom, and colleagues looked at 11.5 million electronic patient records in the US.

Based on that data, the study authors found about 1.1 million patients with diabetes. The authors estimated that 5.4 percent of those had undiagnosed diabetes.

The Centers for Disease Control and Prevention (CDC) has estimated that the disease goes undiagnosed in 27.8 percent of the US population with diabetes. About 12 percent of Americans have diabetes, the CDC reports.

“Strategies to improve detection are clearly needed, because prompt diagnosis is a prerequisite to high-quality diabetes care,” the authors wrote.

Dr. Holt and colleagues noted that the review of electronic medical records may hold an answer. He and his team used electronic databases that included data on glucose (blood sugar) levels to find those who had probable undiagnosed diabetes.

The study authors noted that the proportion of those with undetected diabetes was higher in parts of Arizona, North Dakota, Minnesota, South Carolina and Indiana. Why this was happening in those areas was unclear.

“These people were immediately identifiable through simple searches of electronic medical records from primary care practices," the authors wrote.

Electronic registers have long been used in health care in the UK, but the US has taken longer to adopt them.

"Undiagnosed diabetes is a problem throughout the world because the condition often develops gradually and in the early stages may produce symptoms that are vague and non-specific," Dr. Holt told dailyRx News. "People may not feel inclined to report such symptoms to their physician, or may not attend  follow up of borderline or abnormal blood results. By the time a diagnosis is made, complications may already be established — complications that might have been avoided through earlier detection of the condition."

Dr. Holt said symptoms of diabetes include excessive thirst, urinating more often than normal and unexplained weight loss.

Type 2 diabetes is a condition in which the body produces the hormone insulin but doesn’t use it properly. Insulin normally helps cells process blood sugar (glucose). In type 1 diabetes, the body doesn’t produce insulin at all.

Markers for diabetes include measures of fasting blood glucose and glycated hemoglobin (HbA1c). Fasting blood glucose measures blood sugar after a person hasn’t eaten for eight hours. HbA1c is a measure of a patient's average blood sugar over the past three months.

“Whether fasting blood glucose, random blood glucose or HbA1c values are used, the detection of diabetes is a prerequisite to high-quality care,” the authors wrote. “Our results suggest a need for heightened recognition and follow-up of these signals in patients not known to have diabetes.”

The study was published Nov. 4 in CMAJ Open.

GE Healthcare funded the study. Two study authors disclosed conflicts of interest with S2 Statistical Solutions, a paid consultant to the study sponsor. One author was the president of the company, and another served as a paid consultant for it. Another author was an employee of GE Healthcare during the study.

Review Date: 
November 4, 2014