From Symptoms to Diagnosis: Informing Health Promotion Strategies for Undiagnosed Diabetes Mellitus
Abstract
Diabetes mellitus (DM) remains a major global health concern, with a substantial proportion of cases remaining undiagnosed. Delayed detection is particularly problematic in countries with high disease burden, where individuals often present only after complications have developed. Early-stage type 2 diabetes is frequently asymptomatic or characterized by subtle and non-specific manifestations, contributing to diagnostic delay and missed prevention opportunities. This study aims to identify patient-recognizable “warning” indicators observed prior to formal diagnosis and to examine their relevance for health promotion and opportunistic screening. A qualitative case study approach was employed to explore symptom experiences among individuals previously undiagnosed with DM. Data were analyzed descriptively to generate insight into how these manifestations may function within early detection pathways. The findings indicate that hypertension, neuropathic complaints (such as numbness and tingling), excessive daytime sleepiness, and persistent fatigue commonly preceded diagnosis. These manifestations are not diagnostic in themselves; rather, they function as pragmatic screening prompts that may facilitate earlier symptom appraisal and engagement with health services when interpreted alongside established metabolic risk factors. The study underscores the importance of integrating symptom awareness with risk-based screening, confirmatory testing, and structured referral pathways. Reframing everyday symptom experience as an entry point into coordinated detection systems may help reduce diagnostic delay and strengthen health promotion strategies for undiagnosed diabetes mellitus.
References
Antar SA, Ashour NA, Sharaky M, Khattab M, Ashour NA, Zaid RT, et al. Diabetes mellitus: Classification, mediators, and complications; A gate to identify potential targets for the development of new effective treatments. Biomedicine & Pharmacotherapy. 202;168:115734. https://doi.org/10.1016/j.biopha.2023.115734
Lu Y, Wang W, Liu J, Xie M, Liu Q, Li S. Vascular complications of diabetes: A narrative review. Medicine. 2023;102:e35285. https://doi.org/10.1097/MD.0000000000035285
Mota RI, Morgan SE, Bahnson EM. Diabetic Vasculopathy: Macro and Microvascular Injury. Curr Pathobiol Rep. 2020;8:1–14. https://doi.org/10.1007/s40139-020-00205-x
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. https://doi.org/10.1016/j.diabres.2019.107843
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119
Putra K, Kusumo MP, Prayitno P, Wicaksana D, Arrayyan AZ, Pratama SG, et al. Optimizing the Performance of AI Model for Non-Invasive Continuous Glucose Monitoring: Hyperparameter Tuning and Random Oversampling Approach. JOIV : International Journal on Informatics Visualization. 2024;8:991. https://doi.org/10.62527/joiv.8.2.2047
Hidayati RW, Rukmi DK. The BENAR RELAXATION THERAPY (BRT) DECREASING PSYCHOLOGIC SYMPTOMS IN DIABETES TYPE II IN CANDIBINANGUN DISTRIC. Jurnal Keperawatan Respati Yogyakarta. 2021;8. https://doi.org/10.35842/jkry.v8i2.606
8. Elafros MA, Callaghan BC. Diagnosis and Management of Diabetic Neuropathies. Continuum (N Y). 2023;29:1401–17. https://doi.org/10.1212/CON.0000000000001291
9. Duan D, Kengne AP, Echouffo-Tcheugui JB. Screening for Diabetes and Prediabetes. Endocrinol Metab Clin North Am. 2021;50:369–85. https://doi.org/10.1016/j.ecl.2021.05.002
10. Banday MZ, Sameer AS, Nissar S. Pathophysiology of diabetes: An overview. Avicenna J Med [Internet]. 2020;10:174–88. https://doi.org/10.4103/ajm.ajm_53_20
11. Farmaki P, Damaskos C, Garmpis N, Garmpi A, Savvanis S, Diamantis E. Complications of the Type 2 Diabetes Mellitus. Curr Cardiol Rev. 2021;16:249–51. https://doi.org/10.2174/1573403X1604201229115531
12. Ling W, Huang Y, Huang Y-M, Fan R-R, Sui Y, Zhao H-L. Global trend of diabetes mortality attributed to vascular complications, 2000–2016. Cardiovasc Diabetol. 2020;19:182. https://doi.org/10.1186/s12933-020-01159-5
13. Tollan K, Jezrawi R, Underwood K, Janus M. A Review on Early Intervention Systems. Curr Dev Disord Rep. 2023;10:147–53. https://doi.org/10.1007/s40474-023-00274-8
14. Peer N, Balakrishna Y, Durao S. Screening for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 2020;2020. https://doi.org/10.1002/14651858.CD005266.pub2
15. Vasavada A, Taub LFM. Diabetes Mellitus Screening. StatPearl Publishing; 2025.
16. Susilo DH, Kusbaryanto, Kusumo MP. Diabetes Mellitus Management during the Coronavirus disease-19 Pandemic: Literature Review. Open Access Maced J Med Sci. 2021;9:541–8. https://doi.org/10.3889/oamjms.2021.6597
17. Kusumo MP, Affandi Y, Mei Chan C. Prototype of Integrated Health Service System for Diabetes Mellitus Prevention: Indonesian Population. BIO Web Conf. 2024;137:02006. https://doi.org/10.1051/bioconf/202413702006
18. Kim HJ, Lee H-W, Kang M-K, Leem GH, Kim M-H, Song T-J. Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study. Diabetes Metab J. 2024;48:1093–104. https://doi.org/10.4093/dmj.2023.0243
19. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Diabetes Care. 2015;38:1777–803. https://doi.org/10.2337/dci15-0012
20. Prasetyo J, Sulistyowati T, Fatah NA, Rachmatulaili, Hidayat I. Efforts To Improve Early Detection of Diabetes Mellitus in UPTD Puskesmas Ngasem Kediri District. Journal of Community Engagement in Health. 2025;8:255–63. https://doi.org/10.30994/jceh.v8i2.678
21. Idayani S, Tandea GA, Adnyani W. SKRINING KESEHATAN PADA MASYARAKAT SEBAGAI UPAYA PENCEGAHAN PENYAKIT TIDAK MENULAR. PENA DIMAS: Jurnal Pengabdian Masyarakat. 2024;3. https://doi.org/10.33474/penadimas.v3i1.24144
22. Barroga E, Matanguihan GJ, Furuta A, Arima M, Tsuchiya S, Kawahara C, et al. Conducting and Writing Quantitative and Qualitative Research. J Korean Med Sci. 2023;38. https://doi.org/10.3346/jkms.2023.38.e291
23. Worku A, Arage FG, Kebede FB. Introduction to health care data analytics- an overview. Discover Health Systems. 2025;4:107. https://doi.org/10.1007/s44250-025-00291-x
24. Saputra N, Tur APA. Three generational bearers’ diverging perception on nicknames in Rokan Hulu, Riau. NOTION: Journal of Linguistics, Literature, and Culture. 2025;7:39–50. https://doi.org/10.12928/notion.v7i1.11699
25. Memon MA, Thurasamy R, Ting H, Cheah J-H. PURPOSIVE SAMPLING: A REVIEW AND GUIDELINES FOR QUANTITATIVE RESEARCH. Journal of Applied Structural Equation Modeling. 2024;9:1–23. https://doi.org/10.47263/JASEM.9(1)01
26. Ogbonnaya C, Kindred M, Lavie CJ, Oh H, Shin M-J, Sui X, et al. Association Between Trunk Fat Mass Index and Diabetes in a Multinational Population. Mayo Clin Proc Innov Qual Outcomes. 2025;9:100658. https://doi.org/10.1016/j.mayocpiqo.2025.100658
27. Perhimpunan Dokter Hipertensi Indonesia. KONSENSUS PENATALAKSANAAN HIPERTENSI 2019 [Internet]. Lukito AA, Harmeiwaty E, Hustrini NM, editors. Jakarta: Indonesian Society of Hypertension: Perhimpunan Dokter Hipertensi Indonesia; 2019 [cited 2026 Feb 3]. https://www.inash.or.id/news-detail.do?id=411. Accessed 3 Feb 2026
28. Amin A, Asri Y, Maharani AS. Association Between Diabetes Mellitus and Hypertension Severity at a Primary Health Care Center in Indonesia. Vitamin : Jurnal ilmu Kesehatan Umum. 2026;4:103–12. https://doi.org/10.61132/vitamin.v4i1.2045
29. Hezam AAM, Shaghdar HBM, Chen L. The connection between hypertension and diabetes and their role in heart and kidney disease development. Journal of Research in Medical Sciences. 2024;29. https://doi.org/10.4103/jrms.jrms_470_23
30. Marcus ME, Reuter A, Rogge L, Diba F, Marthoenis, Vollmer S. Hypertension and diabetes screening uptake in adults aged 40–70 in Indonesia: a knowledge, attitudes, and practices study. BMC Global and Public Health. 2025;3:44. https://doi.org/10.1186/s44263-025-00157-7
31. Firdausi S, Manik N, Palmado I, Liandhajani, Halim G. Edukasi Kesehatan serta Pemeriksaan Kadar Gula Darah dan Tekanan Darah untuk Masyarakat Kelurahan Jatiwarna Kecamatan Pondok Melati Kota Bekasi. Journal of Community Development. 2026;6:10. https://doi.org/10.47134/comdev.v6i3.1867
32. Bell DSH, Jerkins TW. Diabetic distal symmetric polyneuropathy: More than just “tingling in the feet.” Diabetes Obes Metab. 2026;28:817–25. https://doi.org/10.1111/dom.70235
33. Ziegler D, Tesfaye S, Spallone V, Gurieva I, Al Kaabi J, Mankovsky B, et al. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Res Clin Pract. 2022;186:109063. https://doi.org/10.1016/j.diabres.2021.109063
34. Anastasiou G, Liberopoulos E, Tentolouris N, Papanas N. Diabetic Sensorimotor Polyneuropathy: An Overview on Epidemiology, Risk Factors, Classification, Diagnosis, and Treatment. Int J Low Extrem Wounds. 2024; https://doi.org/10.1177/15347346241240513
35. Wondie A, Taderegew MM, Girma B, Getawey A, Tessema Z, Emrie AA, et al. Excessive daytime sleepiness and its predictors among type 2 diabetes mellitus patients at central ethiopia. Sci Rep. 2024;14:31693. https://doi.org/10.1038/s41598-024-81073-y
36. Bi Y, Zhang L, Li X, Kan Y, Li S, Zou Y, et al. Contributing factors of fatigue in patients with type 2 diabetes: A systematic review. Psychoneuroendocrinology. 2021;130:105280. https://doi.org/10.1016/j.psyneuen.2021.105280
37. Kuo H-J, García AA, Huang Y-C, Zuñiga JA, Benner AD, Cuevas H, et al. Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis. The Science of Diabetes Self-Management and Care. 2023;49:438–48. https://doi.org/10.1177/26350106231205029
Refbacks
- There are currently no refbacks.
Copyright (c) 2026 Mahendro Prasetyo Kusumo
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
___________________________________________________________________________________________________________________________________
Jurnal Penelitian Kesehatan SUARA FORIKES (Journal of Health Research FORIKES VOICE), e-ISSN: 2502-7778, p-ISSN 2086-3098
Volume 1-6 (2010-2015) are available at http://suaraforikes.webs.com)
+6282132259611 (phone and WhatsApp)
___________________________________________________________________________________________________________________________________