Abstract
Over a third of adults in the United States have prediabetes, and many of those with prediabetes will progress to type 2 diabetes within 3–5 years. Health insurance status may factor into a proper diagnosis of prediabetes and diabetes. This study sought to determine the associations between health insurance and undiagnosed prediabetes and diabetes in a national sample of American adults. Publicly available data from 13,029 adults aged 18–64 years from the 2005–2016 waves of the National Health and Nutrition Examination Survey were analyzed. Health insurance type (Medicaid, Private, Other, None) was self-reported. Prediabetes and diabetes status were assessed with measures of self-report, glycohemoglobin, fasting plasma glucose, and two-hour glucose. Covariate-adjusted logistic models were used for the analyses. Overall, 5976 (45.8%) participants had undiagnosed prediabetes, while 897 (6.8%) had undiagnosed diabetes. Having health insurance was associated with decreased odds ratios for undiagnosed prediabetes: 0.87 (95% confidence interval (CI: 0.79, 0.95)) for private insurance, 0.84 (CI: 0.73, 0.95) for other insurance, and 0.78 (CI: 0.67, 0.90) for Medicaid. Moreover, having private health insurance was associated with 0.82 (CI: 0.67, 0.99) decreased odds for undiagnosed diabetes. Health insurance coverage and screening opportunities for uninsured individuals may reduce prediabetes and diabetes misclassifications.
Highlights
The health consequences and increasing prevalence of type 2 diabetes are substantial public health burdens at both individual and population levels
The principal results of this investigation revealed that health insurance was associated with decreased odds for undiagnosed prediabetes or diabetes in American adults
Sex and age factored into the associations of health insurance type on undiagnosed prediabetes and type 2 diabetes
Summary
The health consequences and increasing prevalence of type 2 diabetes are substantial public health burdens at both individual and population levels. Type 2 diabetes reduces quality of life, increases multimorbidity risk, and accelerates time to mortality [1,2]. These complications have pronounced economic implications on healthcare systems, especially as the prevalence of those with type 2 diabetes continues to grow [1,3,4,5]. As the American population ages and the prevalence of individuals with type 2 diabetes continues to rise, projections place the number of diagnosed type 2 diabetes cases in the United States around 39 million by the year 2050 [1]. Lifestyle alterations and pharmacologic interventions in those with prediabetes
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