A third of laboratory-confirmed diabetes is not coded, not treated, or both

Design

Retrospective national cohort, claims linked to laboratory results

Population

27,650 US adults with new laboratory-confirmed diabetes, 2017–2023

Primary outcome

Diagnostic coding and drug treatment within 1 year

Effect

66.6% both; 19.7% code only; 4.1% treatment only; 9.6% neither

This retrospective cohort linked US commercial and Medicare claims from 2017 to 2023 with laboratory results. It followed 27,650 adults whose results met the threshold for diabetes and who had no earlier diabetes or prediabetes record, for one year after that result.

Only 66.6% received both a type 2 diabetes diagnosis code and a glucose-lowering prescription within the year. Another 19.7% were coded but not treated, 4.1% were treated without a code, and 9.6% had neither. The higher the HbA1c, the more likely both steps were; the heavier the comorbidity burden, the less likely.

The last finding is the uncomfortable one. Patients with many other problems are exactly the ones whose new diabetes slips behind the issue that brought them in. A result that crosses the diagnostic line belongs on the problem list at that visit, with a plan and a named follow-up, rather than being left for the next appointment to notice.

• When an HbA1c of 6.5% or more comes back, code the diagnosis at that visit rather than waiting for a repeat to be arranged later.
• Patients with heavy comorbidity were the least likely to be coded or treated: check new results in this group deliberately.
• A mildly raised HbA1c (6.5–6.9%) was the band most often left without action; it still needs a documented plan.
• Audit your own clinic list for results above the diagnostic threshold with no diabetes code attached.

Why it matters

The patients most likely to be missed are the multimorbid ones with the most to lose from untreated diabetes.

Don't overread it

Claims cannot capture lifestyle-only management, so some of the 'untreated' group may have had a deliberate plan.

The statistics, in plain English

These are claims data, so 'no treatment' means no prescription claim: some patients may have been managed with lifestyle advice alone, which claims cannot show. The figures describe how often follow-through happened, not why it failed.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.