Why 3 in 10 People with Diabetes Don’t Know They Have It

New research on diabetes suggests that nearly 30% of adults with diabetes remain undiagnosed—the same rate as people with HIV. And just like many HIV patients, only about 20% of diabetes patients are treated satisfactorily, finds the new study published in the Annals of Internal Medicine.

The study used the cascade of care method, which aggregates data on people’s treatment for a particular disease and has been used to guide treatment of HIV/AIDS. Study leaders say that the new diabetes research is the first time the method has been applied to another disease.

The research found a lot of similarities between the two diseases and how they’re managed. To start, the consequences can be grave for patients who don’t receive treatment for either disease. HIV/AIDS weakens the immune system and allows patients to develop other ailments, while diabetes can lead to problems with the kidney, heart and brain. Researchers showed where people with diabetes fall through the cracks on the path from the onset of a condition to the development of other serious illnesses. Millions aren’t diagnosed, more than a million people haven’t been to the doctor in years despite a diagnosis and millions of others don’t take the proper medication.

“As health care systems move from fee-for-service to fee-for-quality, something like the cascade can really aid in that shift and help both providers and patients be more motivated and spot the gaps and close the gaps in care,” said study co-author Mohammed Ali, an assistant professor at Emory University. Incentives could encourage both patients and health care providers to screen and then treat diabetes.

“They’re extremely similar because they both require patients to be extremely proactive in managing their own condition,” said Ali, specifically citing diet, exercise and taking medication. “If you’re a good patient, you’re actually going to prevent a lot of those diseases that come with diabetes and a lot of those bad outcomes that come with HIV.”

As electronic records make it easier for doctors to look at large sets of data, the cascade-of-care method has potential to aid in understanding where the health system has failed at treating diseases, Ali said.

“This should be easy to do for anything,” he said.

Corrected Nov. 11, 2014: This piece has been updated. An earlier version of the story mischaracterized statements from Ali.