The under-diagnosis of diabetes and its associated risk factors in older adults from Mexico, China, and South Africa

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Date

2020

Authors

Hudson, Mimi
Hudson, Mimi
DeLouize, Alicia
Snodgrass, Josh

Journal Title

Journal ISSN

Volume Title

Publisher

University of Oregon

Abstract

Underdiagnosis of diabetes and impaired glucose tolerance is a problem in many parts of the world, despite the well-documented negative effects on health. The longer that diabetes goes undiagnosed, the worse these effects are and the more difficult they become to treat. Previous studies have shown that the increasing rates of type 2 diabetes globally are closely related to changes in lifestyle and socioeconomic status. It is those in poorer countries, along with the minority and disadvantaged groups in wealthy countries, that face the biggest risk. Although there is much information available on the increasing prevalence of diabetes, many studies fail to report the underdiagnosis rate (the rate of self-reported diabetes compared to the actual rate of diabetes, as measured by blood measures such as glucose or glycated hemoglobin [HbA1c]) of diabetes. Biomarker and survey data on older adults (age ≥ 50) living in Mexico from Wave 1 of the World Health Organization’s Study on global AGEing and adult health (SAGE; N = 12,945) were used to compare self-report diagnosed diabetes to measured HbA1c level available from dried blood spot samples. Results indicate that 7%, 10%, and 77% of participants had diabetes (HbA1c ≥ 6.5%) yet had not been previously clinically diagnosed in China, Mexico, and South Africa respectively. Yet, 94% to 98% of people that had diabetes without a diagnosis reported receiving healthcare the last time they needed it. In all three countries, people that had diabetes without a diagnosis were more likely to rate their health as better than people with diabetes and a diagnosis (b's = 0.45 to 0.80, p's < .05). In China and South Africa, people with smaller amounts of wealth (b's = -1.18 to -0.96, p's < .001) and people living in rural areas (b's = 0.57 to 0.78, , p's < .001) were more likely to lack a diagnosis for diabetes. Other predictors include being male in South Africa (b = 0.34, p = .02) and being younger in China (b = -.04, p < .001) The underdiagnosis of diabetes is a huge health concern, with otherwise healthy individuals that do not utilize available healthcare services having the highest rates of underdiagnosed diabetes.

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Keywords

Underdiagnosis of Diabetes, Type 2 Diabetes, underdiagnosis, diabetes

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