Delay in Diagnosis of Diabetes Is Not the Patient's Fault

Previous reports have suggested that onset of diabetes occurs 4–7 years before clinical diagnosis (1). However, it is not known whether delay in diagnosis reflects patient factors, such as lack of medical visits or glucose measurements, or provider factors, such as clinical inertia (2).We reviewed the charts of 50 patients selected for delayed diagnosis at the Atlanta Veterans Affairs (VA) Medical Center. Date of first diabetes range hyperglycemia (D1) was defined by outpatient fasting plasma glucose (0630–1000 h) ≥126 mg/dl, random glucose (1001–1800 h) ≥200 mg/dl, 2-h post–oral glucose tolerance test (OGTT) glucose ≥200 mg/dl, or A1C ≥6.5%. Date of second diabetes range hyperglycemia (D2) was defined by having any two of these values or any value twice. The date …