Type 2 diabetes diagnosis: over 2 year wait

UK Biobank study of over 200,000 people reveals an average wait of 2.3 years before type 2 diabetes is diagnosed. Being female, having a lower BMI and lower blood sugar levels were associated with delayed diagnosis.

New research presented today at the Diabetes UK Professional Conference (DUKPC) 2021 has revealed that people living with undiagnosed type 2 diabetes are waiting more than two years before receiving a clinical diagnosis.

The findings build on preliminary data that suggested screening those aged 40-70 years would ensure a timely diagnosis of type 2 diabetes, allowing people to get the treatment they need to live well and avoid serious, potentially life-altering diabetes complications.

There are around 4.8 million people living with diabetes in the UK – including around 1 million who have undiagnosed type 2 diabetes. Approximately 90% of people with diabetes have type 2, where the pancreas can’t produce enough insulin, or the insulin that is produced doesn’t work properly. If not managed carefully, diabetes can lead to serious complications that include problems with the heart, kidneys and eyes.

Common symptoms of diabetes – such as going to the toilet a lot, being really thirsty, feeling more tired than usual and losing weight without trying – often come on slowly in people with type 2 and can be easy to miss, especially in the early stages. This means the condition can go undetected for many years, and by the time people are diagnosed they may have already developed complications. Early diagnosis is vital in ensuring people get the treatment and support they need to manage the condition and reduce their risk of serious complications.

The team of researchers led by Dr Katie Young at the University of Exeter analysed data from 200,000 participants of the UK Biobank who did not have a clinical diagnosis of type 2 diabetes. When participants enter the UK Biobank study – one of the largest health studies in the world – blood samples are taken and their health is monitored over time.

Among the 200,000 people identified, 1% (2,022) had a reported HbA1c (a measure of average blood sugar levels for the last two to three months) of 48mmol/mol (6.5%) or over. This is the threshold at which – when combined with additional measures – type 2 diabetes is diagnosed.

The researchers linked the Biobank data with the individuals’ GP records and found it took an average of 2.3 years following the elevated HbA1c test to receive a clinical diagnosis of type 2 diabetes. Almost a quarter of people (23%) had still not received a diagnosis after five years of having elevated blood sugar levels.

The team examined factors associated with an increased delay in receiving a diagnosis and found that women were likely to wait longer for a diagnosis. They also found that having a lower HbA1c within the type 2 diabetes range, and/or lower BMI, was associated with a delayed diagnosis. The researchers suggest that this was because these people may be less likely to experience symptoms or may be less likely to be given a test to confirm type 2 diabetes.

These findings highlight the importance of attending annual health checks for those aged 40 years and above, to ensure that any elevated blood sugar levels are detected early on. They also emphasise the need for increased awareness among healthcare professionals of the importance of type 2 diabetes checks in women and people of a lower bodyweight.

Dr Katie Young, Postdoctoral Research Associate at the University of Exeter, said:

“The results of this study add to previous research suggesting that population-level screening for type 2 diabetes could potentially identify many cases and improve patient outcomes by allowing lifestyle interventions and diabetes treatment to begin much earlier.

“Unfortunately, screening initiatives such as the NHS Health Check have not been offered or taken up at their normal rate in the past year, due to the coronavirus pandemic. If you’re worried about your risk of type 2 diabetes and want to find out how you can reduce it, visit diabetes.org.uk for more information.”

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

“This research provides clear evidence of delays in the diagnosis of type 2 diabetes. Early diagnosis is the best way to avoid the devastating complications of type 2 diabetes, and offers the best chance of living a long and healthy life with type 2 diabetes.

“Type 2 diabetes can sometimes go undetected for up to 10 years, which can lead to serious complications. While the symptoms of type 2 diabetes can sometimes be tricky to spot in the early stages, it’s important to know the signs to look out for, and if you notice anything unusual, speak to your GP.

“12.3 million people in the UK are at an increased risk of developing the condition, but many will be unaware of their risk. We urge anyone concerned about type 2 diabetes to use Diabetes UK’s free online Know Your Risk tool. It could be the vital first step towards getting a diagnosis and getting the right care to stay healthy.”