Prevalence of Diabetes Among U.S. Refugees and Opportunities to Improve Screening, 2012-2022

This project aimed to describe diabetes prevalence and evaluate diabetes screening among newly arrived U.S. refugees. We included refugees ≥ 18 years who underwent domestic medical exams (DME) at three sites between January 2012-September 2022. Data was obtained from electronic health records. We identified refugees with diagnosed diabetes at DME using ICD-9/10 diagnosis codes. Refugees were classified as having undiagnosed diabetes if they had a diabetes diagnosis code or hemoglobin A1c ≥ 6.5% within 3 months of DME. Among refugees without diagnosed diabetes at DME, we used modified American Diabetes Association Standards of Care 2022 criteria to classify them as "screening-eligible." We considered refugees as receiving diabetes screening if they had a hemoglobin A1c or fasting glucose result. Demographic data included patient age, sex, race, ethnicity, and country of origin. We provide prevalence of diagnosed and undiagnosed diabetes and evaluate diabetes screening among newly arrived refugees. We included 4,521 refugees, 127 (2.8%) had diagnosed diabetes at DME, and 244 (5.4%) were diagnosed with diabetes within 3 months. Of those without known diabetes at DME (n = 4,384), 63.3% (n = 2,863) were screening-eligible and of those, 25.4% (n = 726) had screening within 3 months. While the prevalence of overall diabetes among newly arriving refugees was lower than the general U.S. population (8.2% vs. 11.6%), this may be an underestimate as only one-fourth of screening-eligible patients were screened. Adding routine diabetes screening recommendations to DME guidance may decrease the time for diabetes diagnosis for refugee patients.