Community-based Diabetes Screening Research Articles

Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study

Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89–0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08–0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14–0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.

Knowledge and attitudes regarding effect of diabetes mellitus on eyes and community-based screening for diabetes, hypertension, and visual impairment in central India- a community-based cross-sectional study

Background: Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This study was planned to assess knowledge regarding diabetes mellitus and their views and perspectives on diabetes and diabetes related eye diseases and to screen for diabetes, hypertension, and visual impairment in central India.Methods: A cross sectional study was conducted during annual holy celebrations in the metropolitan city of Mumbai. A large cohort underwent habitual visual acuity assessment (HVA), diabetes screening by random finger prick blood sugar, blood pressure screening. A questionnaire survey was administered to every 5th participant who registered for the free screening. All the variables were analysed using descriptive statistics to calculate frequencies, mean, range and chi-square test was used for analytical statistics.Results: A total of 6300 participants were surveyed. More than two third of the study participants (79.5%) know about diabetes and raised blood sugar level causes problem. Around 87.3% had good knowledge about diabetes. Around 42.7% of the study participants never had eye examination in their lifetime. Nearly 40% of participants were screened positive for hypertension and 23.9% had raised blood sugar level. Unfortunately, 6.0% had visual impairment on visual acuity examination.Conclusions: Despite our study shows that majority of the participants had knowledge about diabetes mellitus and importance of eye screening, only half of the people with diabetes mellitus underwent routine eye examination or screening.

EHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon

Assess the effect of selected low-cost eHealth tools on diabetes/hypertension detection and referrals rates in rural settings and refugee camps in Lebanon and explore the barriers to showing-up to scheduled appointments at Primary Healthcare Centers (PHC). Community-based screening for diabetes and hypertension was conducted in five rural and three refugee camp PHCs using an eHealth netbook application. Remote referrals were generated based on pre-set criteria. A phone survey was subsequently conducted to assess the rate and causes of no-shows to scheduled appointments. Associations between the independent variables and the outcome of referrals were then tested. Among 3481 screened individuals, diabetes, hypertension, and comorbidity were detected in 184,356 and 113 per 1000 individuals, respectively. 37.1% of referred individuals reported not showing-up to scheduled appointments, owing to feeling better/symptoms resolved (36.9%) and having another obligation (26.1%). The knowledge of referral reasons and the employment status were significantly associated with appointment show-ups. Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities.

Community-Based Diabetes Screening and Risk Assessment in Rural West Virginia.

This project utilized a cross-sectional study design to assess diabetes risk among 540 individuals from 12 counties using trained extension agents and community organizations in West Virginia. Individuals were screened for diabetes using (1) the validated 7-item diabetes risk assessment survey and (2) hemoglobin A1c tests. Demographic and lifestyle behaviors were also collected. The average age, body mass index, and A1c were 51.2 ± 16.4, 31.1 ± 7.5, and 5.8 ± 0.74, respectively. The majority were females, Non-Hispanic Whites with no prior diagnosis of diabetes. Screenings showed that 61.8% of participants were at high risk for diabetes. Family history of diabetes (siblings or parents), overweight or obese status, sedentary lifestyle, and older age were commonly prevalent risk factors. Higher risk scores computed from the 7-item questions correlated positively with higher A1c (r = 0.221, P < 0.001). In multivariate logistic regression analyses, higher diabetes risk was predicted by obesity, older age, family history of hypertension, and gestational diabetes. Females were 4 times at higher risk than males. The findings indicated that community-based screenings were an effective way to assess diabetes risk in rural West Virginia. Linking diabetes screenings with referrals to lifestyle programs for high risk individuals can help reduce the burden of diabetes in the state.

The Health System and Population Health Implications of Large-Scale Diabetes Screening in India: A Microsimulation Model of Alternative Approaches

BackgroundLike a growing number of rapidly developing countries, India has begun to develop a system for large-scale community-based screening for diabetes. We sought to identify the implications of using alternative screening instruments to detect people with undiagnosed type 2 diabetes among diverse populations across India.Methods and FindingsWe developed and validated a microsimulation model that incorporated data from 58 studies from across the country into a nationally representative sample of Indians aged 25–65 y old. We estimated the diagnostic and health system implications of three major survey-based screening instruments and random glucometer-based screening. Of the 567 million Indians eligible for screening, depending on which of four screening approaches is utilized, between 158 and 306 million would be expected to screen as “high risk” for type 2 diabetes, and be referred for confirmatory testing. Between 26 million and 37 million of these people would be expected to meet international diagnostic criteria for diabetes, but between 126 million and 273 million would be “false positives.” The ratio of false positives to true positives varied from 3.9 (when using random glucose screening) to 8.2 (when using a survey-based screening instrument) in our model. The cost per case found would be expected to be from US$5.28 (when using random glucose screening) to US$17.06 (when using a survey-based screening instrument), presenting a total cost of between US$169 and US$567 million. The major limitation of our analysis is its dependence on published cohort studies that are unlikely fully to capture the poorest and most rural areas of the country. Because these areas are thought to have the lowest diabetes prevalence, this may result in overestimation of the efficacy and health benefits of screening.ConclusionsLarge-scale community-based screening is anticipated to produce a large number of false-positive results, particularly if using currently available survey-based screening instruments. Resource allocators should consider the health system burden of screening and confirmatory testing when instituting large-scale community-based screening for diabetes.

The performance of the Finnish Diabetes Risk Score, a modified Finnish Diabetes Risk Score and a simplified Finnish Diabetes Risk Score in community-based cross-sectional screening of undiagnosed type 2 diabetes in the Philippines

AimThe performance of the Finnish Diabetes Risk Score (FINDRISC) and 2 modifications in community screening for undiagnosed type 2 diabetes (UDD) in the Philippines was evaluated. MethodsActive community-based screening for diabetes was conducted where FINDRISC assessment was done. Modified (modFINDRISC) and simplified (simpFINDRISC) versions were rendered based on Asian standards, study results, and local context. Diabetes was diagnosed through 2 separate blood glucose tests. Areas under the receiver operating characteristic curve (ROC-AUC) and statistics for diagnostic tests for FINDRISC and the modifications were analyzed. ResultsComplete data was collected from 1752 people aged 20–92; 8.6% tested positive for diabetes. ROC-AUC for UDD were 0.738 (FINDRISC), 0.743 (modFINDRISC) and 0.752 (simpFINDRISC). The differences between the FINDRISC and the modifications were not statistically significant (p=0.172). ConclusionsThe performance of all 3 risk score calculators in the screening for UDD in the Philippines was good and may be useful in populations having similar characteristics. Considering the setting and resource constraints, the simpFINDRISC is preferred.

Total n-3 fatty acid and SFA intakes in relation to insulin resistance in a Canadian First Nation at risk for the development of type 2 diabetes.

The present study sought to investigate the associations of total n-3 fatty acid and SFA intakes with insulin resistance in a Canadian First Nation sample at risk for type 2 diabetes. Fasting values for glucose and insulin were used to estimate insulin resistance by homeostasis model assessment (HOMA-IR). Intakes of n-3 fatty acids and SFA were computed from dietary food and drink data obtained using 3 d food records. Associations between HOMA-IR and dietary n-3 and SFA consumption were tested using linear regression models accounting for age, sex, community, education, physical activity, waist circumference, fibre, protein and carbohydrate intakes, and HDL-cholesterol and TAG concentrations. Rural Okanagan region of British Columbia, Canada. On-reserve First Nation individuals (Interior Salishan) aged 18 years and over, recruited for community-based diabetes screening and determined to be normoglycaemic (n 126). HOMA-IR was negatively associated with dietary n-3 fatty acid intake (β = -0·22; 95 % CI -0·39, -0·04; P = 0·016) and positively associated with dietary SFA intake (β = 0·34; 95 % CI 0·15, 0·53; P = 0·0 0 1). Intake of dietary n-3 fatty acids may be protective against whereas SFA intake may promote insulin resistance in this high-risk Canadian First Nation sample. Reduced dietary SFA intake and greater n-3 fatty acid intake may assist the prevention of glycaemic disease among First Nations peoples. More rigorous, controlled trials are required to test whether dietary supplementation with n-3 fatty acids in natural or supplement-based form might reduce diabetes risk in high-risk aboriginal groups.

The association between anxiety and measures of glycaemia in a population‐based diabetes screening programme

To investigate associations between anxiety and measures of glycaemia in a White European and South Asian population attending community-based diabetes screening. In total, 4688 White European and 1353 South Asian participants (aged 40-75 years) without a previous diagnosis of Type 2 diabetes underwent an oral glucose tolerance test and HbA(1c) measurement, detailed history, anthropometric measurements and completed the short-form Spielberger State Trait Anxiety Inventory. Anxiety was significantly higher in South Asian participants (mean 34.1; sd 0.37) compared with White European participants (mean 29.8; sd 0.13). Significant correlations were not identified between anxiety and fasting (r = -0.01, P = 0.75), 2-h glucose (r = -0.10, P = 0.24) or HbA(1c) (r = 0.01, P = 0.40). Anxiety levels at screening were greater among South Asian people. Fasting, 2-h plasma glucose and HbA(1c) are not affected by anxiety during screening tests for diabetes. Current and proposed screening methods for diagnosis of diabetes are not affected by anxiety at screening.

Impact and cost of a 2-week community-based screening and awareness program for diabetes and cardiovascular risk factors in a Swiss canton

Background:Community-based diabetes screening programs can help sensitize the population and identify new cases. However, the impact of such programs is rarely assessed in high-income countries, where concurrent health information and screening opportunities are common place.Intervention and methods:A 2-week screening and awareness campaign was organized as part of a new diabetes program in the canton of Vaud (population of 697,000) in Switzerland. Screening was performed without appointment in 190 out of 244 pharmacies in the canton at the subsidized cost of 10 Swiss Francs per participant. Screening included questions on risk behaviors, measurement of body mass index, blood pressure, blood cholesterol, random blood glucose (RBG), and A1c if RBG was ≥7.0 mmol/L. A mass media campaign promoting physical activity and a healthy diet was channeled through several media, eg, 165 spots on radio, billboards in 250 public places, flyers in 360 public transport vehicles, and a dozen articles in several newspapers. A telephone survey in a representative sample of the population of the canton was performed after the campaign to evaluate the program.Results:A total of 4222 participants (0.76% of all persons aged ≥18 years) underwent the screening program (median age: 53 years, 63% females). Among participants not treated for diabetes, 3.7% had RBG ≥ 7.8 mmol/L and 1.8% had both RBG ≥ 7.0 mmol/L and A1c ≥ 6.5. Untreated blood pressure ≥140/90 mmHg and/or untreated cholesterol ≥5.2 mmol/L were found in 50.5% of participants. One or several treated or untreated modifiable risk factors were found in 78% of participants. The telephone survey showed that 53% of all adults in the canton were sensitized by the campaign. Excluding fees paid by the participants, the program incurred a cost of CHF 330,600.Conclusion:A community-based screening program had low efficiency for detecting new cases of diabetes, but it identified large numbers of persons with elevated other cardiovascular risk factors. Our findings suggest the convenience of A1c for mass screening of diabetes, the usefulness of extending diabetes screening to other cardiovascular risk factors, and the importance of a robust background communication campaign.

Observations and Recommendations for Community-Based Diabetes Screenings

Community-based diabetes screening is common, but its impact on health outcomes is unclear. Screening protocols may not be standardized nor reflect current clinical practice. A community and clinical team examined the quality and consistency of community-based screening to diagnose hyperglycemic states, and it developed a bilingual screening tool to allow screeners to present accurate, actionable results to participants. The team interviewed providers and community members, analyzed forms and educational materials utilized by screeners, and observed local diabetes screening events. Researchers compared glucose parameters used by screeners to published guidelines and observed fingerstick techniques and protocols for education, referral, and follow-up. Screening was divided into 3 phases: participant assessment before testing, obtainment of a sample, and interpretation of and counsel about results. There was a general lack of consistency in diabetes screening practices at the 12 screenings attended and among the 11 screeners interviewed. Assessment rarely included evaluation of diabetes risk factors or recent caloric intake. Obtaining a sample through fingersticks often included practices known to cause discomfort and decrease accuracy of glucose measurements. Criteria used to categorize results as "normal" or "abnormal" rarely followed published guidelines for laboratory-measured glucose values and varied significantly between screeners. No organization mentioned prediabetes in screenings. Postscreening consultation protocols varied widely. Inconsistencies and inaccuracies in screening practices may limit the quality and relevance of community-based diabetes screenings. The impact of local screenings may be enhanced by using a tool that includes concrete steps and precise guidelines.

What happens after community-based screening for diabetes in rural and Indigenous individuals?

Rural individuals (mostly Indigenous) were screened for undiagnosed diabetes and cardiovascular risk. A subsequent survey showed roughly half engaged in timely follow-up with the health care system. The Mobile Diabetes Screening Initiative identifies a substantial number of people needing medical attention, who may otherwise be “missed” through conventional healthcare delivery.

Increasing rates of diabetes and cardiovascular risk in Métis settlements in northern Alberta

Objectives. To determine the prevalence of diabetes (using secondary data analysis), as well as undiagnosed diabetes and pre-diabetes (using primary research methods) among adult Métis Settlement dwellers in northern Alberta. We also sought to identify cardiovascular risk factors.Study design. Quantitative research study utilizing both population census and community-based diabetes screening data.Methods. Self-reported diabetes was analyzed from the results of the Métis Settlement specific censuses in 1998 and 2006. Mobile clinics travelled into each of the 8 Métis Settlement communities in Alberta recruiting 693 subjects for screening for undiagnosed diabetes, pre-diabetes and metabolic syndrome. Logistic regression analyses (adjusted for age and sex) were used to identify associated factors.Results. According to the censuses, 4,312 Métis individuals were living on Settlements in 1998 and 5,059 in 2006. Self-reported age-adjusted prevalence of diabetes increased significantly from 5.1% in 1998 to 6.9% in 2006 (p<0.01), with a crude prevalence increase of 66% (p<0.01). In 2006, diabetes prevalence was higher among females than males, 7.8% vs. 6.1% respectively (p<0.05). Of the 266 adults screened in the fasting state, 5.3% had undiagnosed diabetes, whereas 20.3% (Canadian Diabetes Association criteria) and 51.9% (American Diabetes Association criteria) had 434 International Journal of Circumpolar Health 68:5 2009 pre-diabetes. Rates of obesity and metabolic syndrome were 49.4% (n=693) and 46.4% (n=266), respectively. Hemoglobin A1c>6.1% was strongly associated with diabetes, pre-diabetes and metabolic syndrome.Conclusions. Our results indicate high rates of diabetes, undiagnosed diabetes, pre-diabetes and metabolic syndrome among adult Alberta Métis Settlement dwellers.

Differences in the prevalence of diabetes risk-factors among First Nation, Métis and non-Aboriginal adults attending screening clinics in rural Alberta, Canada

Populations that are developing (westernizing) are suffering the highest rates of increases in diabetes incidence and prevalence worldwide, with the most notable and documented increases in Canada seen among the First Nations. Less is known about the Métis (mixed blood) or the rural populations in general. To date, no studies have assessed the contributions of ethnicity to diabetes risk-factors. Our objective was to examine diabetes risk factors in First Nations, Métis and non-Aboriginal individuals residing in rural or remote locations, investigating whether ethnicity contributed to any differences. From the databases of three separate community-based diabetes screening projects in Alberta we created a unique subject pool of 3148 adults without diabetes (1790 First Nation, 867 Métis, and 491 non-Aboriginals). Age, body mass index (BMI), waist circumference, reported history of gestational diabetes (GDM) or babies over nine pounds (females only), hemoglobin A1c (A1c) fasting plasma glucose (FPG) or random plasma glucose (RPG) were assessed. Chi-square tests and logistic regression analysis were used to identify between-group differences. The highest mean values for waist circumference (104.7 cm) and BMI (31.2) were found in First Nations subjects (p<0.01). First Nations individuals had the highest prevalence of overweight/obesity (84.4%), abnormal waist circumference (76.8%) and history of GDM (9.0%) (p<0.01). The RPG was also higher in First Nations, but there were no differences between groups with respect to mean FPG and A1c levels, and there were no differences with respect to the prevalence of pre-diabetes or undiagnosed diabetes. Métis (OR 0.80; p = 0.01) and non-Aboriginal individuals (OR 0.62; p< 0.01) were less likely to be obese after age/gender adjustment, compared with First Nations. Métis (OR 0.70; p<0.01) and non-Aboriginals (OR 0.35; p<0.01) were also less likely than the First Nations group to have abnormal waist circumferences. Individuals in the non-Aboriginal group had a lower prevalence of pre-diabetes (OR 0.50; p = 0.01) compared with both the Métis and First Nations groups. First Nations individuals had more risk factors for diabetes than Métis and non-Aboriginal individuals, although Métis rates appeared intermediate. While these risk-factor differences did not translate to more undiagnosed diabetes or pre-diabetes, they are consistent with known rates of diagnosed diabetes in Alberta.

Association between smoking, insulin resistance and beta-cell function in a North-western First Nation.

Aboriginal peoples have a high prevalence of smoking and are at major risk for diabetes. The role of insulin resistance vs. compromised beta-cell function in the link between smoking and glycaemic disease is not clear. This study tested whether relations between insulin resistance and beta-cell function differ between current smokers, former smokers and non-smokers, and if having diabetes modifies smoking-related effects. A community-based diabetes screening initiative was mounted for a North-western First Nation (Interior Salishan) in rural British Columbia, Canada. Respondents were on-reserve Aboriginal people (n=156), all adults 18+ years. Glycaemic status was determined by oral glucose tolerance test. Fasting values for glucose and insulin were used to estimate beta-cell function and insulin resistance by homeostasis model assessment (HOMA). Analyses adjusted for age, sex, alcohol intake, education, body mass index and physical activity. For normoglycaemic persons (n=119) current smokers relative to non-smokers had high beta-cell values [difference (95% confidence interval) 19.5 (17.1, 21.9)], while former smokers had low beta-cell values [difference -22.8 (-20.3, -25.3)] (P<0.0001). For diabetic persons (n=37) differences were of equivalent direction but greater magnitude (P<0.0001). Insulin resistance was for normoglycaemic persons highest for current smokers, and for diabetic persons lowest for current smokers (P=0.021). Former smoking is associated with low beta-cell function, and current smoking with high beta-cell function, independent of diabetes in the North-western First Nation surveyed. Associations between smoking and insulin resistance vary according to glycaemic status. Smoking may have diametric acute and post-cessation effects on beta-cell function and insulin resistance.

Community-based screening for diabetes in Michigan.

To describe and evaluate a community-based diabetes screening program supported by the Michigan Department of Community Health. Between 1 June 1999 and 31 December 1999, community screening for diabetes was conducted by voluntary organizations using a standard protocol, American Diabetes Association (ADA) questionnaires, and ADA capillary plasma glucose criteria. A total of 3506 individuals were screened, 14% of whom did not meet criteria for screening. Of the 3031 individuals appropriately screened, 57% were classified as being at high risk based on the ADA questionnaire and 5% had positive screening tests based on ADA capillary plasma glucose criteria. Despite systematic follow-up, the screening program's yield of individuals with undiagnosed diabetes was <1%. Community screening for diabetes conducted according to ADA recommendations was extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes screening questionnaire resulted in many false positive tests, and the ADA criteria for positive plasma glucose tests likely missed a substantial portion of individuals with undiagnosed diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting medically underserved individuals might improve the yield of community-based diabetes screening.

Fasting criteria for screening: test properties and agreement with glucose tolerance

The objective of this study was to characterise test properties and agreement for fasting glucose cut-offs used for screening diabetes in Indigenous Australian communities, across a range of diabetes prevalence. The oral glucose tolerance test (OGTT) was administered to adult volunteers ( n=3249) for community-based diabetes screening in isolated settlements ( n=25). Two-hour post-load glucose concentration was the ‘gold standard’ against which test properties were characterised for fasting plasma glucose cut-offs at concentrations of ≥7.0 mmol/l (ADA criterion) and ≥7.8 mmol/l (WHO criterion). Test sensitivity (95% CI) was greater for the ADA (72.5%, 67.4–77.1%) versus the WHO criterion (61.5%, 56.1–66.6%). Specificity was high (>98%) using either criterion. The post-test likelihood of diabetes, given a population prevalence of 14.8%, was 89.1% using the ADA criterion, and 94.9% using the WHO criterion. The ADA criterion gave better agreement than did the WHO criterion for diabetes prevalence ≥8.6%, and the probability of false results was lower using the ADA criterion, when diabetes prevalence was ≥12.8%. According to the ADA criterion most individuals ascribed false negative results were aged ≥35 years, overweight/obese, or had impaired fasting glucose. The fasting glucose criterion of 7.0 mmol/l was superior to 7.8 mmol/l in screening for diabetes.