Undiagnosed diabetes: does it matter?

Abstract

Background: The 1998 Canadian clinical practice guidelines for the management of diabetes lowered the cutoff point for diagnosing diabetes mellitus from a fasting plasma glucose (FPG) level of 7.8 to 7.0 mmol/L. We studied the prevalence and clinical outcomes of undiagnosed and diagnosed diabetes within specific ranges of FPG among a cohort of subjects recruited in 1990.

Methods: In 1990 a representative sample of 2792 adult residents of Manitoba participated in the Manitoba Heart Health Survey, which included measurement of FPG and a question about each participant's past history of diabetes. Individuals who would now be classified as having undiagnosed diabetes under the new criteria were not considered as such in 1990. Through data linkage with the provincial health care utilization database, the use of health care by these individuals was tracked and compared with that of individuals whose diabetes had been diagnosed and with that of normoglycemic individuals over an 8-year period subsequent to the survey.

Results: The prevalence of undiagnosed diabetes in the adult population of Manitoba was 2.2%. Undiagnosed cases accounted for about one-third of all diabetes cases. Individuals with undiagnosed diabetes had an unfavourable lipid profile and higher blood pressure and obesity indices than normoglycemic individuals. Individuals who satisfied the new criteria for diabetes but remained undiagnosed had an additional 1.35 physician visits per year (95% confidence interval [95% CI] 0.93-1.96) and were more likely to be admitted to hospital at least once (odds ratio 1.23, 95% CI 0.40-3.79), compared with normoglycemic individuals.

Interpretation: Undiagnosed cases represent the unseen but clinically important burden of diabetes, with significant concurrent metabolic derangements and a long-term impact on health care use.

Fig. 1: Prevalence of diabetes and impaired fasting glucose in the adult population of Manitoba, according to the 1997 ADA criteria. IFG = impaired fasting glucose, UnDxDM = undiagnosed diabetes, DxDM = diagnosed diabetes.

Fig. 2: Probability of survival among survey cohort members. Non-DM = nondiabetic individuals, DM-new = all individuals considered to have diabetes according to the new criteria, DM-old = all individuals considered to have diabetes according to the old criteria.