title: Type 2 diabetes detection and management among insured adults.
abstract: The 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.
  
  
  
  The 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.
  
  
  
  Among 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.
  
  
  
  This 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.
authors.affiliation: IHS Markit, 1150 Connecticut Ave., NW, Suite 401, Washington, DC 20036 USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Dall
authors.affiliation: The Lewin Group, 3130 Fairview Park Drive, Suite 500, Falls Church, VA 22042 USA.
authors.forename: Weyna
authors.initials: W
authors.lastname: Yang
authors.affiliation: The Lewin Group, 3130 Fairview Park Drive, Suite 500, Falls Church, VA 22042 USA.
authors.forename: Pragna
authors.initials: P
authors.lastname: Halder
authors.affiliation: Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ 08536 USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Franz
authors.affiliation: Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ 08536 USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Byrne
authors.affiliation: IHS Markit, 1150 Connecticut Ave., NW, Suite 401, Washington, DC 20036 USA.
authors.forename: April P
authors.initials: AP
authors.lastname: Semilla
authors.affiliation: IHS Markit, 1150 Connecticut Ave., NW, Suite 401, Washington, DC 20036 USA.
authors.forename: Ritashree
authors.initials: R
authors.lastname: Chakrabarti
authors.affiliation: The Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, 220 Arch St., Room 12-212, Baltimore, MD 21201 USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D019468:Disease Management; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D019458:Insurance Coverage; D007348:Insurance, Health; D007484:Iowa; D008484:Medicaid; D006278:Medicare; D008910:Minnesota; D009515:New Jersey; D015995:Prevalence; D011787:Quality of Health Care; D013781:Texas; D014481:United States / Q000453:epidemiology; D014589:Utah
chemical_list: D007004:Hypoglycemic Agents
keywords: Detection; Diabetes; Management