Undiagnosed Diabetes a Major Concern for 30% Women of Childbearing Age

The prevalence of diabetes is on the rise among young adults in the United States, with particular concern for women of childbearing age (18–49 years). Recent research has uncovered that nearly 5% of non-pregnant women in this age group have been diagnosed with diabetes, and a significant 30% remain undiagnosed. 

This poses a critical health issue as pregnant women in this age bracket with diabetes face a higher risk of severe morbidity and mortality, as well as potential risks to their newborns. Adhering to the complex guidelines for monitoring and controlling diabetes is challenging for this population. 

The American Diabetes Association (ADA) recommends comprehensive diabetes care, which includes regular monitoring, such as HbA1c checks at least twice a year, an annual dilated eye exam, a blood cholesterol test, a foot exam, and influenza vaccination. Following these monitoring guidelines can reduce the risk of uncontrolled diabetes.

However, the study reveals that over half (51.5%) of non-pregnant women of childbearing age with diabetes in the US have uncontrolled diabetes. Uncontrolled diabetes has significant negative impacts, both biologically and emotionally. It can lead to life-threatening complications, including diabetic ketoacidosis, heart attacks, strokes, and periodontitis. Emotionally, it is associated with fears of long-term complications, amputations, hypoglycaemic episodes, and even death. 

The study utilized secondary, longitudinal data from the Medical Expenditure Panel Survey (MEPS) and focused on non-pregnant women aged 18–45 who had been diagnosed with diabetes. The researchers aimed to examine the associations between patient-centred care (PCC) and self-efficacy, healthcare ratings, and management adherence in women of childbearing age with diabetes.

The findings suggest that those who reported optimal PCC had greater diabetes care management adherence. The results align with previous research demonstrating that optimal PCC leads to improved diabetes self-management behaviors, which are linked to better health outcomes and an improved quality of life for those with diabetes.

Notably, non-Hispanic black women in the study had lower odds of reporting higher levels of diabetes care management, emphasizing the need for further research focusing on factors associated with PCC, especially for racial/ethnically minoritized women. However, optimal PCC was not associated with diabetes care self-efficacy in this group.

This finding contradicts previous research that suggests that patient perceptions of PCC improve diabetes care self-efficacy. It may be due to the already high levels of diabetes care self-efficacy observed in this sample. More research is needed to understand the factors that influence diabetes care self-efficacy in this population. 

Providing care to women of childbearing age with diabetes can be complex, as healthcare teams often provide information in a manner that makes it difficult for patients to comprehend and recall. Recent recommendations suggest techniques like “teach-back” to improve patient recall and self-efficacy. Teach-back is an interactive communication loop between the patient and provider that encourages patient involvement in diabetes care education.

However, it is underutilized, and healthcare practitioners should consider implementing it to enhance the care of women with diabetes in this age group. The rising prevalence of diabetes among young women of childbearing age is a cause for concern, as uncontrolled diabetes can have severe consequences.

The study highlights the importance of patient-centered care in improving diabetes care management but also underscores the need for further research to understand the factors influencing self-efficacy in this population. Healthcare practitioners should consider using techniques like teach-back to enhance patient education and self-efficacy in diabetes care. 

Journal Reference  

Tiffany B. Kindratt et al, Testing proximal, intermediate, and health outcomes of patient-centered communication among non-pregnant women of childbearing age with diabetes mellitus: Findings from the Medical Expenditure Panel Survey 2012-2018, PEC Innovation (2023). DOI: 10.1016/j.pecinn.2023.100185.