Undiagnosed diabetes is costly

An estimated 6.3 million American adults have diabetes and don’t know it, according to a new study. But ignorance is not bliss — or cheap. These undiagnosed type-2 diabetics experience more medical problems than healthy adults their age. The new study takes a stab at calculating those: $18 billion a year.

“To the best of our knowledge, no study has investigated the health care use patterns and economic costs for patients with undiagnosed diabetes,” the authors report in the latest issue of the bimonthly Population Health Management.

To calculate how many diabetics await diagnosis, researchers from two healthcare consulting firms tapped the National Health and Nutrition Examination Survey. This federal program periodically collects information on health and diet from statistically representative cross-sections of the U.S. population. Many participants in each survey are checked for blood-sugar concentrations to identify the share of people with undiagnosed diabetes or who are at high risk of developing the metabolic disorder.

Based on the NHANES data, authors of the new study, led by Yiduo Zhang of the Lewin Group in Falls Church, Va., were able to extrapolate how many people should have similar blood-sugar problems in the U.S. population generally (keeping in mind that incidence rates for diabetes vary by gender and ethnicity, with men and blacks at higher risk).

Earlier research had indicated that diabetes can take up to eight years to develop. So the researchers identified a population of newly diagnosed diabetic patients and then tallied their health-care costs — from doctor’s visits and prescriptions to hospitalizations for all causes — that they incurred over the two years preceding their diagnosis. To attribute what share might be due to nascent diabetes, the researchers compared these costs to those for the same period in a demographically similar population that remained healthy.

Health costs in undiagnosed diabetics varied by age, the study found: from a low of about $580 annually in the elderly to $1,900 a year for people through age 45 and $2,960 for people 45 to 64. Once diagnosed, costs associated with diabetes go up. That’s largely because individuals now have new prescription-drug costs and start receiving referrals to endocrinologists and other specialists to start managing their diet and lifestyle in ways that keep blood-sugar levels under control

As someone who knows several diabetics, I can testify that managing and treating complications associated with their chronic disease is challenging and costly. However, study after study has shown that early diagnosis and treatment minimizes those complications, which include vascular disease, poor wound healing andblindness.

The new study points out that there are a lot of people who are already silently sick and who need to get with the program — the blood-glucose-management program — before they incur substantially more costly problems. Such as irreversible damage to their heart, arteries and kidneys.

One thing the researchers didn’t address in their paper, but what I suspect can aggravate the number of individuals who remain undiagnosed — especially these days — is our sick economy. For people who are out of work and now uninsured, costs associated with doctor’s visits and diabetes’ treatment can break the bank. So the unemployed seldom go looking for potential health problems. And for people worried about layoffs (and potentially having to enter a different insurance system in the next year or two), being saddled with a diagnosed “preexisting illness” — one that the new insurer may not touch for a year — can be scary.

Of course, coping with complications of diabetes or any other chronic ailment should be even scarier.

One solution to reducing the ranks of the undiagnosed may be better, more affordable healthcare. Where even the unemployed can see doctors, seek treatment and stave off the especially dire complications associated with a disease that afflicts some 24 million Americans.

Janet Raloff

Janet Raloff is the Editor, Digital of Science News Explores, a daily online magazine for middle school students. She started at Science News in 1977 as the environment and policy writer, specializing in toxicology. To her never-ending surprise, her daughter became a toxicologist.

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