Undiagnosed diabetes: A high cost for the health system
An immediate issue, and one of tremendous importance, is the under diagnosis of diabetes. A recent estimate from the National Diabetes Statistics Report puts the number of undiagnosed diabetics in the U.S. at 8.7 million.
People who are unaware they have diabetes are at risk for progression to the serious complications of high blood sugar such as cardiovascular and renal disease. There are few publications on the causes of under diagnosis. However, we can postulate that they fall into three general groupings:
1) Lack of access to care;
2) Failure to obtain screening for diabetes;
3) Inaction on the part of patients who screen positive but do not follow up, or do not understand that they have diabetes.
Access to care, as measured by those with insurance coverage, has clearly improved with the implementation of insurance exchanges and Medicaid expansion under the Affordable Care Act. However, it is not yet clear how many people are actually seeing primary care and other physicians for check ups and screenings.
Failure to obtain screening is directly related to access to care, but also to what happens during encounters with the healthcare system. If a patient’s encounters primarily consist of emergency or acute care visits, that patient will not likely receive screening for diabetes, breast cancer, colon cancer or a range of other conditions. Even within the context of a primary care visit it is unclear how many Americans receive appropriate screening.