The Missed Patient With Diabetes: How access to health care affects the detection of diabetes

Abstract

OBJECTIVE -This study examined the association between access to health care and three classifications of diabetes status: diagnosed, undiagnosed, and no diabetes. RESEARCH DESIGN AND METHODS -Using data from the 1999 -2004 NationalHealth and Nutrition Examination Survey, we identified 110 "missed patients" (fasting plasma glucose Ͼ125 mg/dl but without diagnoses of diabetes), 704 patients with diagnosed diabetes, and 4,782 people without diabetes among adults aged 18 -64 years. The population percentage undetected among adults with diabetes and the odds ratio of being undetected among adults who reported not having diabetes were compared between groups based on their access to health care.RESULTS -Among those with diabetes, the percentages having undetected diabetes were 42.2% (95% CI 36.7-47.7) among the uninsured, 25.9% (22.9 -28.9) among the insured, 49.3% (43.0 -55.6) for those uninsured Ͼ1 year, 38.7% (29.2-48.2) for those uninsured Յ1 year, and 24.5% (21.7-27.3) for those continuously insured over the past year. Type of insurance, number of times receiving health care in the past year, and routine patterns of health care utilization were also associated with undetected diabetes. Multivariate adjustment indicated that having undetected diabetes was associated with being uninsured (odds ratio 1.7 [95% CI 1.0 -2.9]) and with being uninsured Ͼ1 year (2.6 [1.4 -5.0]).CONCLUSIONS -Limited access to health care, especially being uninsured and going without insurance for a long period, was significantly associated with being a "missed patient" with diabetes. Efforts to increase detection of diabetes may need to address issues of access to care.

Analysis of Guidelines for Screening Diabetes Mellitus in an Ambulatory Population

“…Uninsured patients who do not come to the clinic were not captured in this study but almost certainly fare worse and remain a vulnerable population that should be targeted for public health outreach in the area of diabetes screening. 27 The strengths of the current study are the large population size and the use and availability of standardized criteria to establish an accurate, comprehensive, and reproducible population. Acknowledging that every retrospective study has inherent limitations, we chose at every opportunity the most strict definition for inclusion criteria or risk factor definition.…”

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Screening for diabetes in dental settings

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