Ask an Expert: How Do People Get Diagnosed With Type 2 Diabetes?

About 1 in 10 people in the United States live with type 2 diabetes, but about 1 in 5 of these people don’t know they have it.

And when it comes to diabetes management, ignorance is not bliss.

Do-Eun Lee, MD, an endocrinologist who specializes in diabetes treatment, tells Verywell Health that late diabetes detection can increase someone’s risk of having more severe complications down the road, some of which are life-threatening. More sobering still, she adds that undetected or late-diagnosed diabetes appears more common among minority patients or people who are otherwise vulnerable than people who are White.

According to the Centers for Disease Control and Prevention (CDC), 14.5% of Indigenous, 12.1% of Black, 11.8% of Latinx, and 9.5% of Asian American adults have type 2 diabetes, compared to 7.4% of White Americans.

There is hope, however. Early detection may mitigate these risks and give people tools to manage their condition—or fully recover.

Below, Dr. Lee discusses what healthcare providers look for when diagnosing someone with type 2 diabetes and how early detection may help minimize complications.

Verywell Health: How does a person get diagnosed with type 2 diabetes?

Dr. Lee: Typically, people get diagnosed with type 2 diabetes at an annual physical. They might have been fine a year prior, but their new bloodwork shows abnormalities.

A minority of people experience symptoms of diabetes, like frequent urination and thirst, and then actively seek out urgent care or a primary care physician to get diagnosed. Not many people go to the emergency room to get diagnosed these days—because they don’t have to. A lot of times, the annual blood work includes a test for A1C, high levels of which can diagnose someone with diabetes.

Verywell Health: Can you explain that more? What is A1C?

Dr. Lee: A1C is “glycated hemoglobin.” Hemoglobin circulates in our bloodstream, and when you have high sugar, your percentage of glycation in it will go up. Typically, normal people would have glycated hemoglobin levels of under 5.6%. But the higher sugar in your bloodstream, the more glycated hemoglobin you will have—and that percentage will go up. I’ve seen glycated hemoglobin levels in people with type 2 diabetes range from 6.5% to 10%, which is pretty high.

Verywell Health: What type of societal barriers might prevent people from getting diagnosed with type 2 diabetes?

Dr. Lee: Non-Caucasian, lower socioeconomic status people sometimes skip annual bloodwork as they focus on their jobs and work. People with busy work lives may let their symptoms go for a while and just chalk it up to whatever they think their symptoms may result from.

Often, in my patient base, I see A1C a lot higher at the time of diagnosis in the Hispanic, Filipino, or African American populations—perhaps because they don’t seek medical care as quickly.

Verywell Health: How do higher levels of A1C impact someone’s experience with the disease over time?

When you look at clinical trials from The UK Prospective Diabetes Study (UKPDS), the complication rate for people with type 2 diabetes was much lower when their A1C was lower at the beginning of the trial, even if levels evened out later on. And minority populations tend to have higher A1C at the beginning of their disease, which we refer to as metabolic memory. The higher A1C you have in the front, the more likely you will develop complications down the road, even if your levels eventually lower to something more standard or controlled.

Still, this varies, and I think some genetic issues are related to complications. For instance, some people with high A1C and high sugar levels never really develop complications, whereas some people don’t have really high A1C but do develop complications.

Verywell Health: In addition to genetics, what else can influence someone’s risk level?

Dr. Lee: There are racial differences, which relate to genes, and environmental factors. African Americans, Latinos, and Filipinos tend to have more renal complications. Neuropathy, on the other hand, doesn’t seem to differ based on my experience. Kidney involvement seems to vary by race and genetics and can be slightly skewed to African Americans and Filipino Latinos.

Verywell Health: What advice would you give people who are hesitant to see a healthcare provider or get bloodwork to check their A1C levels?

Dr. Lee: I think it’s crucial to get tested for type 2 diabetes. More than a third of people in the United States are obese, and more than two-thirds of people are overweight or obese, so everybody has the potential to have diabetes. Checking in to have early detection will increase the chance of reversal and not getting complications.