In this study, the undiagnosed individuals had less elevated HbA1c levels and less lipid treatment compared with diagnosed individuals. However, the undiagnosed were more likely to have poor blood sugar control and poor blood pressure (BP) control.

“This study is the largest addressing this specific issue and is indeed a wake-up call that the U.S. system is a long way behind in its use of electronic records to support systematic, structured care to a large population of very needy individuals,” Dr. Holt told Endocrinology Advisor.  “We are not claiming that physicians do better in the U.K. in terms of diabetes management, but we are suggesting that U.S. doctors could do even better than they are currently if they made consistent use of electronic health records including diabetes registers.”

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It is believed that undiagnosed diabetes is resulting in billions of dollars in health care costs due to complications from untreated disease. Over the past 3 years, only 53.2% of people over the ages of 45 were screened for diabetes, far below what is recommended by the American Diabetes Association.3 

In their study, Casagrande et al conducted a cross-sectional study in which they reviewed responses from 21,519 adults taking part in the 2005-2010 National Health and Nutritional Examination (NHANES) and the 2006 national Health Interview Survey. 

The researchers found that the prevalence of screening for diabetes of U.S. adults aged 20 years and older was 43.6% and focused primarily on people who were overweight and obese. The researchers say it is well known that minorities are at greater risk for type 2 diabetes; however, diabetes screening was less prevalent among minorities.

Adopting another HIV model may be part of the solution. AIDS testing is now widely available in a variety of settings. It may be a good idea to go out and screen individuals for diabetes in the workplace or at churches, according to some experts.  

“The CDC (Centers for Disease Control), based on their epidemiologic studies found that 27% of people are undiagnosed,” said Robert Ratner, MD, who is Chief Scientific & Medical Officer for the American Diabetes Association. “We are now missing a vast number of high-risk people.”

He told Endocrinology Advisor that women who have had gestational diabetes are at very high risk for developing type 2 diabetes and therefore should be screened. Yet, he said that is not the case because the current guidelines don’t call for testing them.  The same can be said for people with metabolic syndrome or lipid disorders.

“There is no one answer,” said Dr. Ali.  “A lot of the care gaps are due to several factors.”

Even so, he said there is a new awareness about the problem and improved screening guidelines are expected to lead to significant improvements in 2015.


  1. Ali MK et al. Ann Intern Med. 2014; 161(10):681-689.
  2. Holt TA et al. CMAJ. doi:10.9778/cmajo.20130095.
  3. Casagrande SS et al. Am J Prev Med. 2014;47(6):780-787.