Type 2 diabetes detection and management among insured adults

Abstract

BackgroundThe Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management.MethodsThe study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max.ResultsAmong insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients.ConclusionsThis study highlights the large number of insured adults with undiagnosed type 2 diabetes by insurance type and state. Furthermore, this study sheds light on other gaps in diabetes care quality among patients with diagnosed diabetes and corresponding poorly controlled diabetes. These findings underscore the need for improvements in data collection and diabetes screening and management, along with policies that support these improvements.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0110-4) contains supplementary material, which is available to authorized users.

Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study

“…Although type 2 diabetes is generally regarded to account for 90-95% of diabetes cases,1 the International Diabetes Federation reported that approximately 87-91% of people with diabetes in high income countries have type 2 diabetes, 7-12% have type 1 diabetes, and 1-3% have other diabetes subtypes 34. One study in the United States using medical claims data estimated that type 2 diabetes accounted for about 92% of cases of diabetes among insured US adults, although the results could not be generalized to the US population 35. The proportion of type 2 diabetes in cases of diagnosed diabetes in the present study (91.2%), based on the most recent prevalence estimates in 2016 and 2017, was comparable to the previously reported prevalence.…”

Impact of Insulin Initiation and Time to Insulin Initiation on within-Person Change of Healthcare Utilization in Medicaid Enrollees with type 2 Diabetes

“…Medicaid, as the primary health insurance program for low-income people in the US, covered about 8% of all individuals with diagnosed diabetes in 2009 (approximately 1.8 million adults) [1,2]. In 2012, nearly 13% of total healthcare expenditures for diabetes was provided by Medicaid (~$28 billion) [3].…”

“…In 2012, nearly 13% of total healthcare expenditures for diabetes was provided by Medicaid (~$28 billion) [3]. For each Medicaid enrollee with T2DM, the age-adjusted annual medical cost was $14,170 in 2012, higher than $9,560 in those with commercial insurance [1], with the annual medical cost increasing to $17,830 for those with a diagnosis code of uncontrolled diabetes (HbA1c > 9%) possibly due to a higher prevalence of diabetes complications [1]. Of Medicaid enrollees with T2DM, only 64% received annual HbA1c test and even a lower portion (58%) had controlled diabetes in 2012 [1].…”

Detection And Management Of Diabetes In England: Results From The Health Survey For England

“…That it can remain asymptomatic for several years contributes to this burden by allowing complications associated with it to accumulate that could be avoided were it detected and managed earlier [8,10,34]. While prompt identification and effective management are clearly important to avoiding such costs, several studies highlight not only the existence of a substantial prevalence of undiagnosed disease [4,14,17,20,28,32] but also the existence of distinct patterns of undiagnosed disease. In the UK, Moody et al [20], for example, found that males, those who are older (greater than 34 years) and those who are ethnic Asians were more likely to have undiagnosed diabetes.…”