As of 2015, 30.3 million American adults had diabetes, but only 23.1 million of them knew about it. That’s close to a quarter of the diabetes population walking around unaware. Diabetes was the 7th leading cause of death in the U.S. in 2015, so how is it that such a serious health condition goes undiagnosed and unaddressed?
Unfortunately, there are several factors that prevent people living with diabetes from getting a diagnosis when they need one.
1. Not knowing, or not understanding, the symptoms
It’s easy to look back and see the writing on the wall after a diagnosis, but in the midst of symptoms, it’s not quite so obvious. Consider these three cases:
Mike, a long-distance runner and former paratrooper, wasn’t overly concerned when his type 1 symptoms started to manifest. He went running a lot, so he attributed his extreme thirst, fatigue, and weight loss to all the miles he was logging. Mike didn’t find out he had diabetes until, as his wife says, “he was pretty close to dead.”
Moira’s daughter Lauren was diagnosed in kindergarten, but not right away. Moira describes seeing all the signs but not understanding them. She knew something was wrong, but she didn’t know what to do. Moira’s friends noticed Lauren’s irritability and weight loss, and even Lauren’s kindergarten teacher was concerned, but no one suspected the truth or suggested that Lauren see a doctor.
Moira says, “I’m a caring, capable and educated mom, and yet: It could have been Lauren [who died]. Luck is what saved her.” Lauren received her diagnosis at a regular annual checkup.
Beverly Cook was shocked to discover she had type 2 diabetes at an office-building health fair, of all things. Sure, she was tired all the time, but she attributed that to working long hours and being overweight. Beverly said that she hadn’t paid a lot of attention to herself and hadn’t suspected anything serious was wrong.
Mike, Moira, and Beverly all saw the signs, but weren’t able to connect the symptoms to the danger. Mike’s wife, Jessica, says, “If we’d known even one thing about type 1 diabetes, we might have had a clue.”
2. Diabetes was missed at the doctor’s office
Before being diagnosed, Mike had gone to the doctor to report numbness in his toes. But Mike didn’t mention all of the other diabetes red-flag symptoms he’d been experiencing. In the absence of other symptoms, the doctor wasn’t concerned about Mike’s numb toes and his real issue went undiagnosed.
Beverly had been to two annual physicals before her health-fair diagnosis. But she didn’t receive a diabetes test even though she had some diabetes risk factors, and so she continued with business as usual.
A 2003 article in The Seattle Times noted that diabetes tests may get lost or forgotten in the gamut of other tests that doctors need to give older patients. There’s also concern that low insurance reimbursements may not incentivize the vital tests.
Of course, doctors can only do so much, and they rely on their patients to share all symptoms and follow through with prescribed tests. Both doctors and patients bear responsibility for diabetes diagnosis and treatment. But doctors can’t diagnose anything if they never see a patient in the first place.
3. Lack of health care options in rural areas
It’s easy to recommend talking to a doctor when someone is having a health issue, but the reality is that seeing a doctor, let alone receiving a diagnosis and treatment plan, can be a huge challenge. In some cases, someone who needs care simply may not be able to get to a health care facility.
One reason people don’t visit a doctor is simply that there’s not one around. According to an article in Diabetes Spectrum, “Rural areas have half as many physicians as do urban areas.” Some areas may have as few as one physician for every 2,000 residents. It may not be an option for someone in such an area to simply drive to another town as they may have limited access to transportation, childcare issues, or mobility challenges. Also, people living in rural areas generally have lower incomes, which can exacerbate existing barriers to care.
In fact, type 2 diabetes, the most prevalent type, is much more common among the elderly and those with lower incomes. It can be hard for these populations to get to a doctor, and even when a patient is able to receive a diagnosis, diabetes requires continued education and follow-up care. If a patient already has significant challenges reaching a health care facility, reaching a diabetes clinic or specialist on a regular basis may not be an option.
Katie Taylor started writing in 5th grade and hasn't stopped since. Her favorite place to pen a phrase is in front of her fireplace with a cup of tea, but she's been known to write in parking lots on the backs of old receipts if necessary. She and her husband live cozily in the Pacific Northwest enjoying rainy days and Netflix.