Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness

Abstract

ObjectivesThe rising prevalence of type 2 diabetes (T2D) in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning health-care services and public health initiatives. MethodsFour screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care glycated hemoglobin (A1C) testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CanRisk survey scores were used to identify the pre-test probability of diabetes. ResultsThe mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including: housing and financial issues (n=53), interpersonal and family issues (n=35), and health or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia. ConclusionsThe high rate of undiagnosed prediabetes and diabetes among people experiencing homelessness reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.