Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.

Mohammad H. Rahbar,Kristina P. Vatcheva,Joseph B. McCormick,Susan P. Fisher-Hoch,Rudolf Kirchmair

doi:10.1371/journal.pone.0133135

Mohammad H. Rahbar, Kristina P. Vatcheva + Show 3 more

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https://doi.org/10.1371/journal.pone.0133135

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Abstract

Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC); a two-stage randomly selected ‘Framingham-like’ cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.

Highlights

In the United States (U.S.) rates of diagnosed type 2 diabetesmellitus have increased from 6.2% (1988–1994) to 10.2% (2005–2010)
The weighted prevalence of diabetes measured in this community was 27.6%; that is, nearly one in three of all adults aged 18 years and older have diabetes (Table 1). (This compares with 20.6% prevalence using the 2006 American Diabetes Association (ADA) definition which does not include HbA1c.) Forty percent of those with diabetes (345 participants) were previously undiagnosed
Overall participants with diabetes reported two years less education and lower annual income than those without diabetes

Summary

Introduction

In the United States (U.S.) rates of diagnosed type 2 diabetesmellitus have increased from 6.2% (1988–1994) to 10.2% (2005–2010). The overall lifetime risk of diabetes (2000–2011) is 40.2% for men and 39.6% for women.[1,2] The lifetime diabetes risk in minorities, is PLOS ONE | DOI:10.1371/journal.pone.0133135. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

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