Type 1 Diabetes Diagnoses Are On the Rise: What Is the PA Role?

Over half of all new cases of type 1 diabetes are now diagnosed in adults

November 21, 2024

By AAPA Research

The changing prevalence of type 1 diabetes
Diagnoses of both type 1 and type 2 diabetes are on the rise in youth in the US. Between 2017 and 2060,  models project a relative increase of 65% in cases of type 1 diabetes in youth under 20 years of age and a staggering 673% in cases of type 2 diabetes in the same patient population.¹ Furthermore, according to the CDC, 1.7 million adults aged 20 years or older—or 5.7% of all U.S. adults with diagnosed diabetes—reported both having type 1 diabetes and using insulin.² Steeper increases in age-adjusted and sex adjusted incidence of type 1 diabetes were seen among blacks (2.7% per year), Hispanics (4.0% per year) and Asians and Pacific Islanders (4.4% per year) than among whites (0.7% per year).³

There has been a shift in our understanding of type 1 diabetes in recent years. Over half of all new cases are now diagnosed in adults. Not all new cases may exhibit a more gradual onset of hyperglycemia nor require insulin initially. Of all adults with a new diagnosis of type 1 diabetes, close to 40% were initially misdiagnosed. These errors increase as the patients age.⁴

So how often do physician associates (PAs) see patients with a diagnosis of type 1 diabetes? Between January 2023 and March 2024, there were 24,809 PAs (or less than 15%) of any specialty who had at least 1 patient with type 1 diabetes. Across PAs, NPs, and physicians who had any patients with this diagnosis, the average number of patients was 4.0, with a high of 5.1 patients for physicians and a low of 3.5 for PAs.⁵

The PA role throughout the patient journey
AAPA recently conducted a survey of PAs to understand the roles they play in the patient’s journey from screening through maintenance of type 1 diabetes. More than half of respondents are involved in screening (53%), diagnosing (60%), referring patients for treatment (66%), and monitoring treatment (55%). A large minority of respondents say that they are initiating treatment (43%).

Figure 1. Percent of PAs participating in each step of the type 1 diabetes patient’s journey

Barriers to patient care
AAPA also asked the PAs about their barriers to optimal patient outcomes for their patients with type 1 diabetes. A few of the more common barriers are ones that we see across most clinical states, such as

• Cost of medications: 54% said this was a somewhat high to high barrier,
• Limited time for patient education: 54% said this was a somewhat high to high barrier, and
• Access to specialists: 39% said this was a somewhat high to high barrier.

Other common barriers that are more specific to type 1 diabetes include:

• Patient adherence to treatment plans: 44% said this was a somewhat high to high barrier, and
• Lack of resources to deal with psychosocial issues impacting patients’ ability to adhere to treatment: 44% said this was a somewhat high to high barrier.

While there is a wealth of resources on the psychosocial impact of the diagnosis of type 1 diabetes for adolescents and their families, there is a recent literature review found very few that looked at the availability of resources for newly diagnosed adults.⁶ The authors were able to pull out three major themes related to the impact of a new diagnosis on the psychosocial health of adult patients newly diagnosed with type 1 diabetes including:

• The impact of the diagnosis on everyday life,
• The influence of psychosocial health on metabolic levels and adaptation, and
• Provision of self-management support.⁶

Impact of perceived barriers on health equity
The National Institute on Minority Health Disparities (NIMHD) identifies several populations that experience health disparities including:

• Racial and ethnic minority groups
• People with lower socioeconomic status (SES)
• Underserved rural communities
• Sexual and gender minority (SGM) groups, and
• People with disabilities.⁷

The barriers to patient outcomes for patients with type 1 diabetes the PAs see have a direct impact on these patient populations. The cost of medications will impede patient outcomes for patients with lower SES. Access to specialists will impede outcomes for patients with lower SES and/or live in rural underserved communities. Adherence impacts all patients, regardless of provider type, but without the resources to deal with the psychosocial issues all of the above patient populations are at risk for suboptimal outcomes despite attempts from any provider to provide high quality care.

What can PAs do?
In your own practice, identify diabetes care coordinators and/or community health workers available to your patients. To reduce the costs, PAs can share resources on drug rebates and facilitate getting 90 day refills rather than 30 days refills for medications and supplies as this is often less expensive for the patient. Finally, findhelp.org allows you to enter a zip code and identify a wealth of resources to address patient needs related to social determinants of health.

AAPA has resources to better equip PAs to work with patients with type 1 and type 2 diabetes from the early signs and symptoms necessitating screening through to clinical maintenance of their disease. Learn more about the Diabetes Toolkit today.

References
1.Tönnies T, Brinks R, Isom S, et al. Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2060: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2023;46(2):313-320. doi:10.2337/dc22-0945.

2.Centers for Disease Control and Prevention. National diabetes statistics report. Diabetes. Published May 21, 2024. https://www.cdc.gov/diabetes/php/data-research/

‌3.Divers J, Mayer-Davis EJ, Lawrence JM, et al. Trends in Incidence of Type 1 and Type 2 Diabetes Among Youths — Selected Counties and Indian Reservations, United States, 2002–2015. MMWR Morbidity and Mortality Weekly Report. 2020;69(6):161-165. doi:https://doi.org/10.15585/mmwr.mm6906a3

‌4.Muñoz C, Floreen A, Garey C, et al. Misdiagnosis and diabetic ketoacidosis at diagnosis of type 1 diabetes: patient and caregiver perspectives. Clin Diabetes 2019;37:276–281 2.Thomas NJ, Lynam AL, Hill AV, et al. Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes. Diabetologia 2019;62: 1167–1172

5.Point of Care Network unpublished data. www.pocn.com and www.pocngroup.com.

6.Due-Christensen M, Bruun LD, Joensen LE, Norgaard O, Andersen TH. Psychosocial aspects and perspectives of adult-onset type 1 diabetes: A systematic scoping review. Diabet Med. 2023;40(5):e15073. doi:10.1111/dme.15073

7.National Institute on Minority Health and Health Disparities. Minority health and health disparities definitions. NIMHD. Published February 9, 2023. https://www.nimhd.nih.gov/resources/understanding-health-disparities/minority-health-and-health-disparities-definitions.html

About the project
This research was sponsored by Sanofi. The research is the work of AAPA, including the survey and the conclusions drawn.

Noel Smith is AAPA’s Senior Director of PA and Industry Research and Analysis. She can be reached at [email protected].

You May Also Like
AAPA’s Diabetes Toolkit for PAs Diabetes as a National Health Priority
CDC’s Diabetes Self-Management Education and Support (DSMES) Toolkit for patients