Evidence of Nephropathy and Peripheral Neuropathy in US Adults With Undiagnosed Diabetes

Richelle J. Koopman; Arch G. Mainous; Heather A. Liszka; John A. Colwell; Elizabeth H. Slate; Mark A. Carnemolla; Charles J. Everett

doi:10.1370/afm.577

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Table 1.

US Prevalence and Population Estimates for Diagnosed, Undiagnosed, and No Diabetes Among Adults Aged ≥40 Years, 1999–2002, Prevalence of Sociodemographic and Health Care Access Factors by Diabetes Status (N = 2,571)

Factors	Diagnosed Diabetes	Undiagnosed Diabetes	No Evidence of Diabetes
* Only for ages 40–64 years.
Unweighted sample size, n	271	132	2,168
Weighted population size(millions), n	11.4	4.8	101.2
Weighted prevalence, %	9.7	4.1	86.3
Age, years
40–64	62.4	64.1	76.0
≥65	37.7	35.9	24.0
Sex, male, %	54.3	63.2	45.5
Race/ethnicity, %
Non-Hispanic white	65.2	77.2	79.0
Non-Hispanic black	11.5	11.6	9.0
Hispanic	17.4	8.0	8.9
Other	5.9	3.2	3.1
No health care utilization, %	3.8	15.3	12.5
No usual place of care, %	3.9	12.1	11.0
No health insurance, %*	8.1	22.4	12.7
Income <$20,000/y, %	34.2	35.8	21.9
Education, %
<High school	31.5	36.7	21.2
High school	21.8	22.8	24.4
>High school	46.8	40.5	54.4
Body mass index ≥30 kg/m², %	46.5	55.4	29.1
Not married, %	34.8	45.5	31.7
Self-rated health status, %
Fair/poor	37.8	24.3	18.9
Hypertension
Diagnosed	65.1	60.9	39.4
Undiagnosed	8.6	15.9	10.2

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Table 2.

Prevalence of Positive Screening Tests for Nephropathy and Peripheral Neuropathy in US Adults Aged ≥40 Years With Diagnosed Diabetes, Undiagnosed Diabetes, and No Diabetes

Screening Test	No Diabetes % (SE)	Undiagnosed Diabetes % (SE)	Diagnosed Diabetes % (SE)
* Difference vs undiagnosed diabetes group significant at P <.05.
† Estimates for peripheral neuropathy exclude participants with a history of stroke.
Nephropathy	9.6 (0.6)*	24.9 (4.4)	28.0 (3.7)
Peripheral neuropathy^†	10.1 (0.9)*	21.5 (5.1)	19.2 (3.4)

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The Article in Brief

Background Although early diagnosis of diabetes can help prevent health problems from the disease, there is evidence that some health problems may develop before diabetes is diagnosed. This is the first large-scale study of how often 2 conditions occur in adults with undiagnosed diabetes: nephropathy, a form of kidney damage from high blood sugar, and peripheral neuropathy, or nerve damage from high blood sugar.

What This Study Found Among adults older than 40 years with undiagnosed diabetes, almost 25% had signs of nephropathy; more than 21% had signs of peripheral neuropathy.

Implications

Undiagnosed diabetes is a serious public health concern.
Health professionals may need to reconsider current approaches for detecting diabetes. Most current approaches wait for medical signs and symptoms, and by then it may be too late to prevent some hea
The authors call for more aggressive diabetes testing based on patients� risk for the disease. They also call on insurers to provide reimbursement for such tests.