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Related Experiment Videos

Outpatient diagnostic errors: unrecognized hyperglycemia.

David Edelman1

  • 1Center for Health Services Research in Primary Care, Durham VA Medical Center, NC 27705, USA. dedelman@acpub.duke.edu

Effective Clinical Practice : ECP
|March 5, 2002
PubMed
Summary
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A significant number of managed care patients show lab results indicating diabetes but lack a formal diagnosis. This highlights a gap in recognizing diabetes, impacting patient care and outcomes.

Area of Science:

  • Endocrinology
  • Public Health
  • Health Services Research

Background:

  • Estimating the prevalence of undiagnosed diabetes is crucial for public health initiatives.
  • Managed care organizations (MCOs) provide a unique setting to study disease prevalence due to integrated data systems.

Purpose of the Study:

  • To determine the prevalence of unrecognized diabetes among patients within a large managed care organization.
  • To identify the proportion of patients with abnormal diabetes-related laboratory results who have not received a formal diagnosis.

Main Methods:

  • Retrospective analysis of administrative, billing, and laboratory data from a large MCO.
  • Patients aged 30+ were evaluated for abnormal hemoglobin A1c or plasma glucose levels.
  • Unrecognized diabetes was defined as abnormal lab results without an ICD-9 diabetes code or documented diagnosis in medical records.

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Main Results:

  • Out of 1426 patients with suggestive lab results, 18% (258 patients) had unrecognized diabetes.
  • Using stricter criteria (high HbA1c or two high plasma glucose tests), 9% (124 patients) had unrecognized diabetes.
  • A significant portion of patients with abnormal diabetes labs lacked evidence of provider recognition.

Conclusions:

  • A substantial proportion of MCO patients exhibit laboratory evidence of diabetes without documented recognition by healthcare providers.
  • The findings suggest potential underdiagnosis and undertreatment of diabetes within managed care settings.
  • This highlights the need for improved screening and diagnostic protocols in MCOs.