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Characteristics of Untreated Diabetes Patients

Study participants with untreated diabetes were significantly more likely to be male, older, currently smoking, have lower HDL cholesterol levels, higher BMI, non-HDL cholesterol levels, and systolic blood pressure….

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Patients should be screened for diabetes and managed at an early stage. Physicians should also be aware of the signs and symptoms of untreated diabetes in order to optimize detection of the disease. This study’s focus was on identifying characteristics of the disease in treated versus untreated diabetic individuals.

A survey was done on a nationally representative sample of Japanese population during 2005 and 2009. The goal was to establish measures for national health promotion, which included a cross-sectional interview and examination on basic health data such as anthropometry, nutritional intake, diet, and lifestyle. Inclusion criteria included participants aged ≥20 years. Exclusion criteria included pregnant women, participants aged <20 years, those with missing HbA1c values, or those with missing information for covariates or exposure variables. Response rates were 60-70%. Blood samples were taken and HbA1c levels were measured. The patients were considered diabetic if current diabetes treatments were given, or if HbA1c levels ≥6.5% or ≥48 mmol/mol. There was no distinction between type 1 and type 2 diabetes. The study was broken down into three groups: diabetics not receiving treatment (untreated diabetes), diabetics on treatment (treated diabetes), and patients without diabetes diagnosis (no diabetes). Multiple 2-sided statistical tests with P-value <0.05 were used for analysis such as t-tests, Chi-squared tests, and multinomial logistic regression.

The total population sample was 20,496 participants, with 748 (3.6%) untreated diabetics, 1,213 (5.9%) treated diabetics, and 18,535 (90.4%) non-diabetics. Participants with untreated diabetes had some characteristics compared to those without diabetes, such as being male, higher age, higher HbA1c levels, higher BMI, higher rates of exercise habits, higher total and non-HDL cholesterol levels, higher triglyceride levels, higher blood pressure (all p-value <0.001), lower HDL cholesterol levels (p-value=0.05), and past/current smoking (p-value=0.006). Among the 748 people with untreated diabetes, 361 (48.3%) were previously diagnosed with diabetes, and 348 (46.5%) had HbA1c levels ≥7.0% or 53 mmol/mol. Similar results were observed for treated diabetics group versus no diabetes group, except that current smoking was not significant (p-value=0.063), and having exercise habits was significant (p-value<0.001)

In conclusion, compared to participants without diabetes, participants with untreated diabetes were significantly more likely to be male, older, currently smoking, have lower HDL cholesterol levels, higher BMI, non-HDL cholesterol levels, and systolic blood pressure.

Practice Pearls:

  • Antihyperlipidemic agents might be responsible for the fact that non-HDL cholesterol was positively associated with untreated diabetes and inversely associated with treated diabetes.
  • Age and BMI were commonly used to detect undiagnosed diabetes.
  • Lipid levels have rarely been used to detect undiagnosed diabetes.

Maki Goto, Atsushi Goto, Nayu Ikeda, Hiroyuki Noda, Kenji Shibuya, Mitsuhiko Noda. "Factors Associated with Untreated Diabetes: Analysis of Data from 20,496 Participants in the Japanese National Health and Nutrition Survey." PLoS ONE 2015; 10(3):e0118749.