Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

Abstract

ObjectivesTo ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes.Design5, annual cross-sectional health examination surveys; data adjusted for complex survey design.SettingRandom selection of private homes across England, new sample annually 2009–2013.Participants5, nationally representative random samples of the general, free-living population: ≥1 adult interviewed in 24 254 of 36 889 eligible addresses selected. 18 399 adults had a valid glycated haemoglobin (HbA1c) measurement and answered the diabetes questions.Main outcome measuresDiagnosed diabetes, undiagnosed diabetes (HbA1c ≥48 mmol/mol), IGR (HbA1c 42–47 mmol/mol).ResultsOverall, 11% of the population had IGR, 2% undiagnosed and 6% diagnosed diabetes. Age-standardised prevalence was highest among Asian (19% (95% CI 16% to 23%), 3% (2% to 5%) and 12% (9% to 16%) respectively) and black participants (17% (13% to 21%), 2% (1% to 4%) and 14% (9% to 20%) respectively). These were also higher among people with lower income, less education, lower occupational class and greater deprivation. Education (OR 1.49 (95% CI 1.27 to 1.74) for no qualifications vs degree or higher) and income (1.35 (1.12 to 1.62) for lowest vs highest income quintile) remained significantly associated with IGR or undiagnosed diabetes on multivariate regression. The greatest odds of IGR or undiagnosed diabetes were with increasing age over 34 years (eg, OR 18.69 (11.53 to 30.28) aged 65–74 vs 16–24). Other significant associations were ethnic group (Asian (3.91 (3.02 to 5.05)), African-American (2.34 (1.62 to 3.38)) or ‘other’ (2.04 (1.07 to 3.88)) vs Caucasian); sex (OR 1.32(1.19 to 1.46) for men vs women); body mass index (3.54 (2.52 to 4.96) for morbidly obese vs not overweight); and waist circumference (2.00 (1.67 to 2.38) for very high vs low).ConclusionsSocial inequalities in hyperglycaemia exist, additional to well-known demographic and anthropometric risk factors for diabetes and IGR.

Prevalence of Undiagnosed Type 2 Diabetes Mellitus and Its Associated Factors Among the Malaysian Population: The 2015 National Health and Morbidity Survey, Malaysia

“…Although the prevalence of 9.2% is lower compared to some Southeast Asian countries; 11.1% in Tamil Nadu (Subramani, Devi, & Shankar, 2014) and 11.1% in Singapore (Huang et al, 2015) but it is nonetheless significantly higher compared to other countries like Canada (2.2%) (Flores-Le Roux et al, 2011) and the United Kingdom (2.0%) (Moody, Cowley, Ng Fat, & Mindell, 2016). These undiagnosed DM in Malaysia could be due to lack of awareness of the necessity of health screening at an earlier age and of early diabetes symptoms.…”

Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study

“…Based on existing literature and care guidelines, index HbA 1c , age, and ethnicity/race were included as fixed effects in these models [19–21]. …”

Detection And Management Of Diabetes In England: Results From The Health Survey For England

“…That it can remain asymptomatic for several years contributes to this burden by allowing complications associated with it to accumulate that could be avoided were it detected and managed earlier [8,10,34]. While prompt identification and effective management are clearly important to avoiding such costs, several studies highlight not only the existence of a substantial prevalence of undiagnosed disease [4,14,17,20,28,32] but also the existence of distinct patterns of undiagnosed disease. In the UK, Moody et al [20], for example, found that males, those who are older (greater than 34 years) and those who are ethnic Asians were more likely to have undiagnosed diabetes.…”

“…While prompt identification and effective management are clearly important to avoiding such costs, several studies highlight not only the existence of a substantial prevalence of undiagnosed disease [4,14,17,20,28,32] but also the existence of distinct patterns of undiagnosed disease. In the UK, Moody et al [20], for example, found that males, those who are older (greater than 34 years) and those who are ethnic Asians were more likely to have undiagnosed diabetes. In the US, Menke et al (2015) [17] similarly found that rates of undiagnosed diabetes were higher among those who were older (45 years plus) and among Asians compared with Whites or younger persons.…”

“…Some such as Lee et al (2015) [15] report a higher prevalence of undiagnosed diabetes among the less well off compared to the better off in Korea, as do Moody et al [20] in the UK and Zhang et al [40] in China. By contrast, others such as [33,41] found no role for income in the US with similar findings by Rathmann et al [25] in Germany.…”