WHO IS MOST AT RISK OF UNRECOGNIZED DIABETES? A STUDY TO INFORM PHARMACIST ACTION
Author(s)
Shalini Rana, PharmD, Magaly Rodriguez de Bittner, PharmD, MS, FAPhA, FNAP, Fadia Tohme Shaya, PhD, MPH.
University of Maryland, Baltimore, MD, USA.
University of Maryland, Baltimore, MD, USA.
Presentation Documents
OBJECTIVES: To examine predictors of unrecognized diabetes in U.S. adults and identify opportunities for pharmacist intervention.
METHODS: Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using SAS. Adults aged ≥18 years with available HbA1c and diabetes questionnaire data were included. Lab-defined DM was defined as HbA1c ≥6.5%, and self-reported DM was defined as answering “yes” to having been told they have diabetes. The outcome was a false negative (lab-defined DM with self-reported no DM). Covariates included sociodemographic characteristics, insurance status, BMI, hypertension, self-rated health, routine place for healthcare, marital status, family income, and language. Survey weights were applied to generate nationally representative estimates. Bivariate analyses and survey-weighted multivariable logistic regression with infinite degrees of freedom were conducted to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: Individuals without a routine place for healthcare had higher odds of a false negative compared to those with routine care (OR=2.38, 95% CI 1.21-4.70). Adults with a college degree or higher had increased odds compared to those with some college or an associate degree (OR=1.97, 95% CI 1.23-3.15). Older age and poorer self-rated health were protective against discordance (per-year OR=0.97, 95% CI 0.95-0.98; poor vs. excellent health OR=0.06, 95% CI 0.02-0.16). Associations with BMI, race/ethnicity, insured status, and family income were weaker or not significant.
CONCLUSIONS: Pharmacists can reduce diagnostic discordance by recognizing lack of routine care as a risk indicator and using clear communication and teach-back strategies, particularly for younger, asymptomatic, and highly educated patients.
METHODS: Data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using SAS. Adults aged ≥18 years with available HbA1c and diabetes questionnaire data were included. Lab-defined DM was defined as HbA1c ≥6.5%, and self-reported DM was defined as answering “yes” to having been told they have diabetes. The outcome was a false negative (lab-defined DM with self-reported no DM). Covariates included sociodemographic characteristics, insurance status, BMI, hypertension, self-rated health, routine place for healthcare, marital status, family income, and language. Survey weights were applied to generate nationally representative estimates. Bivariate analyses and survey-weighted multivariable logistic regression with infinite degrees of freedom were conducted to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: Individuals without a routine place for healthcare had higher odds of a false negative compared to those with routine care (OR=2.38, 95% CI 1.21-4.70). Adults with a college degree or higher had increased odds compared to those with some college or an associate degree (OR=1.97, 95% CI 1.23-3.15). Older age and poorer self-rated health were protective against discordance (per-year OR=0.97, 95% CI 0.95-0.98; poor vs. excellent health OR=0.06, 95% CI 0.02-0.16). Associations with BMI, race/ethnicity, insured status, and family income were weaker or not significant.
CONCLUSIONS: Pharmacists can reduce diagnostic discordance by recognizing lack of routine care as a risk indicator and using clear communication and teach-back strategies, particularly for younger, asymptomatic, and highly educated patients.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR124
Topic
Patient-Centered Research
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)