Predictors of the Lack of Annual Fasting Blood Sugar Screening in US Adults

Abstract

Abstract Background: Diabetes mellitus is a major cause of morbidity and mortality. Many individuals remain undiagnosed. The purpose of this study was to identify predictors of the lack of annual fasting blood sugar (FBS) testing in a representative cohort of U.S. adults. Methods: A total of 257,652 adults ≥18 years from the 2011–2018 National Health Interview Surveys (NHIS) were included. Participants were considered to have had FBS testing if they reported a fasting test for diabetes or high blood sugar in the past 12 months. Predictors of screening utilization were selected using the Anderson Model for Healthcare Utilization, including predisposing (age, sex, race/ethnicity), enabling (smoking, alcohol consumption, physical activity, insurance status, education, citizenship status, region of residence), need (BMI group, comorbidities, cardiovascular disease [CVD]), and healthcare-related factors (doctor visits, satisfactory care, affordability, delayed care). We used diabetes status-stratified multivariable logistic regression with a stepwise selection method to determine the most significant predictors. All analyses accounted for the survey design and weights to obtain nationally representative estimates. Results: Among the 257,652 participants, 115,630 (48%) were male, 27,096 (9.4%) had diabetes, and 141,247 (56%) did not have a FBS test in the past 12 months. Among those with diabetes, 4,529 (16%) did not have a FBS test. Positive predictors of a lack of FBS testing included younger age, male sex, non-Hispanic Black race, ever smoker (≥100 cigarettes), native born, lack of insurance coverage, lack of adequate physical activity, northeast region (relative to west region), no known chronic diseases, and dissatisfactory care. The top 5 most significant predictors of a lack of FBS test in those without diabetes were, in order, 1) no visits to the doctor in the past 12 months (aOR [95% CI]; 5.64 [5.34, 5.96]), 2) insurance status (no coverage vs. coverage; 1.62 [1.54, 1.69]), 3) age group (Ref: ≥65y; 18-35y: 2.45 [2.34, 2.56]; 35-50y: 1.46 [1.40, 1.52]; 50-65y: 1.04 [1.01, 1.08]), 4) BMI group (Ref: Low/Normal; Overweight: 0.79 [0.77, 0.82]; Obese: 0.62 [0.60, 0.64]), and 5) race/ethnicity (Ref: Non-Hispanic White; Non-Hispanic Black: 1.03 [0.98, 1.07], Asian Indian: 0.65 [0.58, 0.74]; Other Asian: 0.91 [0.83, 1.00]; Hispanic/Multiracial: 0.91 [0.86, 0.96]). The top predictors for those with diabetes were similar, although there were significantly greater odds of a lack of FBS testing in Non-Hispanic Blacks vs. Whites (1.24 [1.14, 1.35]). Conclusion: More than half of the participants reported a lack of FBS testing in the past year; among those with diabetes, nearly 1 in 6 reported not having an annual FBS test. This reaffirms the need for long-term patient-physician relationships and aggressive follow-up in younger, male, uninsured, and/or lean individuals with or without diabetes.