{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:26:34Z","timestamp":1784006794074,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Over a third of adults in the United States have prediabetes, and many of those with prediabetes will progress to type 2 diabetes within 3\u20135 years. Health insurance status may factor into a proper diagnosis of prediabetes and diabetes. This study sought to determine the associations between health insurance and undiagnosed prediabetes and diabetes in a national sample of American adults. Publicly available data from 13,029 adults aged 18\u201364 years from the 2005\u20132016 waves of the National Health and Nutrition Examination Survey were analyzed. Health insurance type (Medicaid, Private, Other, None) was self-reported. Prediabetes and diabetes status were assessed with measures of self-report, glycohemoglobin, fasting plasma glucose, and two-hour glucose. Covariate-adjusted logistic models were used for the analyses. Overall, 5976 (45.8%) participants had undiagnosed prediabetes, while 897 (6.8%) had undiagnosed diabetes. Having health insurance was associated with decreased odds ratios for undiagnosed prediabetes: 0.87 (95% confidence interval (CI: 0.79, 0.95)) for private insurance, 0.84 (CI: 0.73, 0.95) for other insurance, and 0.78 (CI: 0.67, 0.90) for Medicaid. Moreover, having private health insurance was associated with 0.82 (CI: 0.67, 0.99) decreased odds for undiagnosed diabetes. Health insurance coverage and screening opportunities for uninsured individuals may reduce prediabetes and diabetes misclassifications.<\/jats:p>","DOI":"10.3390\/ijerph17134706","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T09:36:04Z","timestamp":1593509764000},"page":"4706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Health Insurance Is Associated with Decreased Odds for Undiagnosed Prediabetes and Type 2 Diabetes in American Adults"],"prefix":"10.3390","volume":"17","author":[{"given":"Sean","family":"Mahoney","sequence":"first","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0937-1695","authenticated-orcid":false,"given":"Logan","family":"Pitts","sequence":"additional","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Waletzko","sequence":"additional","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheria G.","family":"Robinson-Lane","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Fairchild","sequence":"additional","affiliation":[{"name":"Centre for Molecular Medicine &amp; Innovative Therapeutics, Murdoch University, 6150 Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna J.","family":"Terbizan","sequence":"additional","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"McGrath","sequence":"additional","affiliation":[{"name":"Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.2522\/ptj.20080020","article-title":"Epidemiology of Diabetes and Diabetes-Related Complications","volume":"88","author":"Deshpande","year":"2008","journal-title":"Am. Phys. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4239\/wjd.v8.i4.120","article-title":"Type 2 diabetes and quality of life","volume":"8","author":"Trikkalinou","year":"2017","journal-title":"World J. Diabetes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.2337\/dc18-1226","article-title":"The economic burden of elevated blood glucose levels in 2017: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes","volume":"42","author":"Dall","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/S2213-8587(15)00519-7","article-title":"The rising cost of diabetes care in the USA","volume":"4","author":"Peter","year":"2016","journal-title":"Lancet Diabete Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s11892-018-1090-5","article-title":"Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults","volume":"18","author":"Bowen","year":"2018","journal-title":"Curr. Diab. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S1098-3597(09)62039-1","article-title":"Identification and Treatment of Prediabetes to Prevent Progression to Type 2 Diabetes","volume":"9","author":"Fonseca","year":"2008","journal-title":"Clin. Cornerstone"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Knowler","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1370\/afm.1946","article-title":"Prevalence of prediabetes and abdominal obesity among healthy-weight adults: 18-year trend","volume":"14","author":"Mainous","year":"2016","journal-title":"Ann. Fam. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40842-019-0080-0","article-title":"Global epidemiology of prediabetes\u2014Present and future perspectives","volume":"5","author":"Hostalek","year":"2019","journal-title":"Clin. Diabetes Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hallberg, S.J., Gershuni, V.M., and Athinarayanan, S.J. (2019). Reversing type 2 diabetes: A narrative review of the evidence. Nutrients, 11.","DOI":"10.3390\/nu11040766"},{"key":"ref_11","first-page":"209","article-title":"Awareness of prediabetes\u2014United States, 2005\u20132010","volume":"62","author":"Li","year":"2013","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1016\/S0140-6736(12)60283-9","article-title":"Prediabetes: A high-risk state for diabetes development","volume":"379","author":"Herder","year":"2012","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.cjca.2017.12.030","article-title":"Prediabetes","volume":"34","author":"Khetan","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.2337\/dc13-0792","article-title":"Implications of rising prediabetes prevalence","volume":"36","author":"Abraham","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"296","DOI":"10.4239\/wjd.v6.i2.296","article-title":"Prediabetes diagnosis and treatment: A review","volume":"6","author":"Bansal","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_16","unstructured":"National Center for Health Statistics (2020, March 04). National Health and Nutrition Examination Survey, 2013\u20132014, Available online: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2013-2014\/documents\/2013-14_overview_brochure.pdf."},{"key":"ref_17","unstructured":"National Center for Health Statistics (2020, March 04). National Health and Nutrition Examination Survey: Plan and Operations, 1999\u20132010, Available online: https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_01\/sr01_056.pdf."},{"key":"ref_18","unstructured":"National Center for Health Statistics (2020, March 04). NHANES Response Rates and Population Totals, Available online: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/ResponseRates.aspx."},{"key":"ref_19","unstructured":"Zipf, G., Chiappa, M., Porter, K.S., Lewis, B.G., Ostchega, Y., and Dostal, J. (2013). National Health And Nutrition Examination Survey: Plan and operations, 1999\u20132010. Vital Heal. Stat. Ser. 1 Programs Collect. Proced., 1999\u20132010."},{"key":"ref_20","unstructured":"American Diabetes Association (2020, March 04). Diagnosis. Available online: https:\/\/www.diabetes.org\/a1c\/diagnosis."},{"key":"ref_21","unstructured":"Centers for Disease Control and Prevention (2020, March 04). Defining Adult Overweight and Obesity, Available online: https:\/\/www.cdc.gov\/obesity\/adult\/defining.html."},{"key":"ref_22","unstructured":"Center on Urban Poverty and Community Development (2020, March 04). Census Poverty and Income Indicators. Available online: http:\/\/neocando.case.edu\/cando\/pdf\/CensusPovertyandIncomeIndicators.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"88","DOI":"10.7812\/TPP\/14-002","article-title":"Prediabetes and lifestyle modification: Time to prevent a preventable disease","volume":"18","author":"Tuso","year":"2014","journal-title":"Perm. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jdiacomp.2016.07.023","article-title":"Ten-year hemoglobin A1c trajectories and outcomes in Type 2 diabetes mellitus: The Diabetes & Aging Study","volume":"31","author":"Laiteerapong","year":"2017","journal-title":"J. Diabetes Complicat."},{"key":"ref_25","first-page":"19","article-title":"Current Population Reports, P60-267, Health Insurance Coverage in the United States: 2018","volume":"267","author":"Berchick","year":"2019","journal-title":"US Census Bur."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.jdiacomp.2017.01.005","article-title":"Predictive models for conversion of prediabetes to diabetes","volume":"31","author":"Yokota","year":"2017","journal-title":"J. Diabetes Complicat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.nurpra.2016.08.005","article-title":"Prediabetes: Screening, Diagnosis, and Intervention","volume":"13","author":"Watson","year":"2017","journal-title":"J. Nurse Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.amepre.2012.12.013","article-title":"Diabetes educators: Skilled professionals for improving prediabetes outcomes","volume":"44","author":"Sherr","year":"2013","journal-title":"Am. J. Prev. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s11606-014-3147-8","article-title":"National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005\u20132012","volume":"30","author":"Kiefer","year":"2015","journal-title":"J. Gen. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1007\/s11606-018-4436-4","article-title":"Performance of the 2015 US Preventive Services Task Force Screening Criteria for Prediabetes and Undiagnosed Diabetes","volume":"33","author":"Bullard","year":"2018","journal-title":"J. Gen. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1007\/s00125-019-4921-2","article-title":"Novel metabolic indices and incident type 2 diabetes among women and men: The Rotterdam Study","volume":"62","author":"Brahimaj","year":"2019","journal-title":"Diabetologia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/s10654-018-0433-5","article-title":"Comparison of the association of predicted fat mass, body mass index, and other obesity indicators with type 2 diabetes risk: Two large prospective studies in US men and women","volume":"33","author":"Lee","year":"2018","journal-title":"Eur. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"k1497","DOI":"10.1136\/bmj.k1497","article-title":"Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: Population based study","volume":"362","author":"Xu","year":"2018","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1001\/jama.2010.843","article-title":"Association between adiposity in midlife and older age and risk of diabetes in older adults","volume":"303","author":"Biggs","year":"2010","journal-title":"J. Am. Med. Assoc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1478-7954-12-12","article-title":"Detecting type 2 diabetes and prediabetes among asymptomatic adults in the United States: Modeling American Diabetes Association versus US Preventive Services Task Force diabetes screening guidelines","volume":"12","author":"Dall","year":"2014","journal-title":"Popul. Health Metr."},{"key":"ref_36","unstructured":"Centers for Disease Control and Prevention (2020, June 29). Increasing Prevalence of Diagnosed Diabetes\u2014United States and Puerto Rico, 1995\u20132010. Morbidity and Mortality Weekly Report (MMWR), Available online: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6145a4.htm?s%3C\/body%3E%3C\/html%3E#:~:text=%2Findex.htm.,In%202010%2C%20an%20estimated%2018.8%20million%20persons%20in%20the%20United,for%20which%20data%20are%20available."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.pcd.2011.12.005","article-title":"Awareness of diabetes risks is associated with healthy lifestyle behavior in diabetes free American adults: Evidence from a nationally representative sample","volume":"6","author":"Okosun","year":"2012","journal-title":"Prim. Care Diabetes"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.2337\/dc12-0081","article-title":"Access to health care and control of ABCS of diabetes","volume":"35","author":"Zhang","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3122\/jabfm.2016.06.160138","article-title":"Prediabetes screening and treatment in diabetes prevention: The impact of physician attitudes","volume":"29","author":"Mainous","year":"2016","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_40","first-page":"1203","article-title":"Self-reported prediabetes and risk-reduction activities\u2014United States, 2006","volume":"57","author":"Rolka","year":"2008","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.numecd.2017.06.004","article-title":"Lower risk of progression from prediabetes to diabetes with health checkup with lifestyle education: Japan Ningen Dock study","volume":"27","author":"Okada","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"253","DOI":"10.2105\/AJPH.2011.300420","article-title":"Identifying unaddressed systemic health conditions at dental visits: Patients who visited dental practices but not general health care providers in 2008","volume":"102","author":"Strauss","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40496-016-0077-z","article-title":"Detection of Undiagnosed Diabetes in the Dental Setting","volume":"3","author":"Grauballe","year":"2016","journal-title":"Curr. Oral Heal. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1377\/hlthaff.2014.1435","article-title":"Estimating the potential impact of insurance expansion on undiagnosed and uncontrolled chronic conditions","volume":"34","author":"Hogan","year":"2015","journal-title":"Health Aff."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Fisher-Hoch, S.P., Vatcheva, K.P., Rahbar, M.H., and McCormick, J.B. (2015). Undiagnosed diabetes and pre-diabetes in health disparities. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133135"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ypmed.2016.09.008","article-title":"The impact of access to health services on prediabetes awareness: A population-based study","volume":"93","author":"Campbell","year":"2016","journal-title":"Prev. Med. (Baltim)"},{"key":"ref_47","unstructured":"Federation, I.D. (2013). IDF Diabetes Atlas, International Diabetes Federation. [6th ed.]."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.annepidem.2015.12.006","article-title":"Prediabetes, undiagnosed diabetes, and diabetes among Mexican adults: Findings from the Mexican Health and Aging Study","volume":"26","author":"Kumar","year":"2016","journal-title":"Ann. Epidemiol."},{"key":"ref_49","unstructured":"Diabetes UK (2020, June 29). Diabetes facts and stats (2015). Available online: https:\/\/mrc.ukri.org\/documents\/pdf\/diabetes-uk-facts-and-stats-june-2015\/."},{"key":"ref_50","unstructured":"(2020, June 05). Centers for Disease Control and Prevention Hispanic\/Latino Americans and Type 2. Diabetes, Available online: https:\/\/www.cdc.gov\/diabetes\/library\/features\/hispanic-diabetes.html."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2015-1137","article-title":"Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus","volume":"37","author":"Harreiter","year":"2016","journal-title":"Endocr. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"440","DOI":"10.2337\/dci17-0005","article-title":"Diabetes and aging: Unique considerations and goals of care","volume":"40","author":"Kalyani","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/1475-6773.13058","article-title":"Response error and the Medicaid undercount in the current population survey","volume":"54","author":"Noon","year":"2019","journal-title":"Health Serv. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/13\/4706\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:45:08Z","timestamp":1760175908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/13\/4706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,30]]},"references-count":53,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17134706"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17134706","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,30]]}}}