Undiagnosed diabetes: Prevalence and cardiovascular risk profile in a population‐based study of 52,856 individuals. The HUNT Study, Norway

Abstract

Aims We investigated the current extent of undiagnosed diabetes and prediabetes and their associated cardiovascular risk profile in a population‐based study. Methods All residents aged ≥20 years in the Nord‐Trøndelag region, Norway, were invited to the HUNT4 Survey in 2017–2019, and 54% attended. Diagnosed diabetes was self‐reported, and in those reporting no diabetes HbA1c was used to classify undiagnosed diabetes (≥48 mmol/mol [6.5%]) and prediabetes (39–47 mmol/mol [5.7%–6.4%]). We estimated the age‐ and sex‐standardized prevalence of these conditions and their age‐ and sex‐adjusted associations with other cardiovascular risk factors. Results Among 52,856 participants, the prevalence of diabetes was 6.0% (95% CI 5.8, 6.2), of which 11.1% were previously undiagnosed (95% CI 10.1, 12.2). The prevalence of prediabetes was 6.4% (95% CI 6.2, 6.6). Among participants with undiagnosed diabetes, 58% had HbA1c of 48–53 mmol/mol (6.5%–7.0%), and only 14% (i.e., 0.1% of the total study population) had HbA1c >64 mmol/mol (8.0%). Compared with normoglycaemic participants, those with undiagnosed diabetes or prediabetes had higher body mass index, waist circumference, systolic blood pressure, triglycerides and C‐reactive protein but lower low‐density lipoprotein cholesterol (all p < 0.001). Participants with undiagnosed diabetes had less favourable values for every measured risk factor compared with those with diagnosed diabetes. Conclusions The low prevalence of undiagnosed diabetes suggests that the current case‐finding‐based diagnostic practice is well‐functioning. Few participants with undiagnosed diabetes had very high HbA1c levels indicating severe hyperglycaemia. Nonetheless, participants with undiagnosed diabetes had a poorer cardiovascular risk profile compared with participants with known or no diabetes.

Prevalence and factors associated with undiagnosed type 2 diabetes among adults in Iraq: analysis of cross-sectional data from the 2015 STEPS survey

“…In agreement with previous studies,13 26 32 33 need indicators (perceived need for health services) in terms of high cholesterol was associated with UT2D. Some previous research15 16 18–20 25 26 30–32 showed a correlation between hypertension and obesity with UT2D versus no T2D, while we found negative associations with UT2D versus DT2D.…”

“…In agreement with previous studies,13 26 32 33 need indicators (perceived need for health services) in terms of high cholesterol was associated with UT2D. Some previous research15 16 18–20 25 26 30–32 showed a correlation between hypertension and obesity with UT2D versus no T2D, while we found negative associations with UT2D versus DT2D. Only cardiovascular disease was positively associated with DT2D, which again may be explained by a higher likelihood of being screened for T2D when attending to healthcare for cardiovascular disease management.…”

“…Enabling/disabling indicators correlated with UT2D consist of socioeconomic status,15 16 18 21 27 28 geolocation and region,13 15–17 healthcare usage frequency,17 health insurance status13 29 and lifestyle factors such as substance use and physical activity 12 19 21 30. Need indicators linked to UT2D consist of chronic conditions,13 such as hypertension,15 16 18 19 30 31 obesity,18–20 25 26 30 32 abnormal lipids26 32 33 and cardiovascular disease 16 19…”

Prevalence and correlates of undiagnosed, diagnosed, and total type 2 diabetes among adults in Morocco, 2017

“…Consistent with some research [13][14][15] , in unadjusted analysis, we found a negative association between hypertension, cardiovascular disease, and undiagnosed T2D versus diagnosed T2D. Unlike some previous studies 22,31,32 , we did not find an association between elevated total cholesterol and undiagnosed T2D. However, we found a statistically significant positive association between elevated total cholesterol and diagnosed T2D.…”

“…The need factors associated with undiagnosed T2D include other chronic diseases 16 , hypertension status (not hypertension 13 , 14 , hypertension 17 , 18 , 29 , 30 ), obesity 17 – 19 , 21 , 22 , 28 , 31 , low HDL-C 31 , 32 , high triglycerides 31 , 32 , dyslipidaemia 22 , cardiovascular disease status (not heart disease 14 , cardiovascular disease 18 ), and perceived poor health 16 . The study aimed to estimate the prevalence and associated factors of undiagnosed T2D among people 18 years and older in Morocco.…”