When it comes to life insurance underwriting, a diabetes diagnosis doesn’t always tell the whole story. From an underwriting perspective, two applicants with diabetes can have very different underwriting outcomes depending on how well their condition is managed.
For agents, understanding the basics of diabetes—and knowing one particularly important number—can help set expectations and make the underwriting process smoother.
Why is diabetes an underwriting concern?
Diabetes is a chronic condition that affects the body’s ability to regulate blood sugar. Over time, elevated blood sugar can increase the risk of serious complications, including heart disease, stroke, kidney disease, and nerve damage.
A1c: The Number Agents Should Know
One of the most important pieces of information agents can gather is the applicant’s Hemoglobin A1c (HbA1c).
An A1c test measures average blood sugar levels over approximately the past two to three months. While a single blood sugar reading provides a snapshot in time, an A1c offers a broader picture of diabetes management.
The following ranges are commonly used to diagnose diabetes:
| A1c Level | General Interpretation |
| Below 5.7% | Normal |
| 5.7%–6.4% | Prediabetes |
| 6.5% or higher | Diabetes |
For many adults with diabetes, an A1c below 7% is a common clinical treatment goal; however, achieving this target does not necessarily translate to a favorable underwriting assessment.
What does this mean for underwriting?
Generally, an A1c near an applicant’s treatment goal suggests better blood sugar management, while higher levels may raise concerns about future complications. However, these medical ranges do not directly translate into underwriting ratings. An applicant’s age, duration of diabetes, treatment, and complications all contribute to the overall assessment.
Why Other Health Conditions Matter
When diabetes is combined with other health conditions, such as high blood pressure, elevated cholesterol, obesity, or heart disease, the overall health risk can increase.
For underwriting, this means that even an applicant with a well-controlled A1c may receive a rating if other significant health concerns are present. The combination of conditions, their severity, and how well they’re managed all play a role in the overall assessment.
Two Applicants, Two Different Risk Profiles
Consider these two hypothetical applicants, both age 55 with Type 2 diabetes.
Applicant 1: A More Favorable History
- A1c: 6.5%
- Diagnosed: 3 years ago
- Treatment: Metformin and lifestyle modifications
- Complications: None reported
- Other health conditions: None reported
- Medical follow-up: Regular physician visits
This applicant demonstrates relatively good blood sugar management, a shorter history of diabetes, and no known complications. These favorable factors may support a more favorable underwriting outcome, depending on the complete medical history.
Applicant 2: A More Challenging History
- A1c: 9.2%
- Diagnosed: 15 years ago
- Treatment: Multiple medications, including insulin
- Complications: Diabetic neuropathy and kidney involvement
- Other health conditions: High blood pressure and elevated cholesterol
- Medical follow-up: Inconsistent
This applicant presents greater underwriting concerns due to elevated A1c, longer disease duration, and existing complications. These factors may result in an additional rating or other underwriting restrictions, including postponement or declination of coverage.
The takeaway? Both applicants have diabetes, but their overall risk profiles are very different. A1c is an important indicator, but it’s only one piece of the underwriting picture.
What Should Agents Ask?
When working with an applicant who has diabetes, gathering a few key details upfront can be valuable:
- What is your most recent A1c, and when was it measured?
- When were you diagnosed?
- What medications or treatments are you using?
- Have there been any recent changes in your treatment?
- How often do you see your physician for follow-up?
- Have you experienced any diabetes-related complications?
The Bottom Line
A diabetes diagnosis doesn’t automatically mean an applicant is uninsurable or will receive a rating.
Knowing your client’s A1c is a great place to start. Understanding that number alongside the duration of diabetes, treatment, and complications can help provide a clearer picture of the risk and support a smoother underwriting process.
This information is provided only as a description of how certain medical conditions may affect the underwriting and issuing of life insurance, and it is not intended to be an exhaustive list of the underwriting consideration relevant to this or any other impairment. Every application is underwritten based on multiple considerations specific to the applicant including health status, medical history, prescription history, financial history and driving history, among other things. National Life Group reserves the right to underwrite applicants based on any and all permissible impairments and considerations. This information is not intended to be a prognosis or to otherwise provide medical advice. Please refer any client questions about their health or medical condition(s) to their healthcare professional.
TC9228110(1126)1
