Effective and Cost Efficient Model for Diabetes Screening/Diagnosis and Assessment of Diabetic Management in a Community-based, Third-World Setting

Mustafa H Alibhai, MD1, Mufadal M Moosabhoy, MD2, Elizabeth Littlejohn, MD3, Rebecca Lipton, PhD3. 1BMI of Texas, 2Hindsdale Pediatric Associates, 3University of Chicago

Background: Diabetes prevalence is expected to increase from 2.8% in 2000 to 4.8% in 2030. Point-of-Care (POC) Hemoglobin A1c (A1C) testing kits developed in 2008 and ADA guidelines from 2009 for diagnostic use of A1C made it plausible to use POC A1C kits for community-based diabetes screening and evaluation of known diabetic management in a developing country.

Methods: In 2009 & 2010, diabetes screening was performed in Gujarat, India at medical camps held during Muslim sermons led by Dawoodi Bohra Muslim leader, Dr. Syedna Mohammed Burhanuddin (TUS). People ≥40 yrs old and/or with known diabetes could participate. All were tested for random blood glucose (RBG). Those with RBG≥200mg/dl or known diabetes received POC A1C testing, body mass index (BMI), blood pressure, and physician consultation. All were given educational pamphlets and their test results.

Results: No Prior Diabetes: 3,453 participants were screened. 169 (4.9%) had RBG≥200mg/dl. 151 had A1C testing, of which 50 (33%) had pre-diabetes levels (A1C=5.7–6.4%) and 72 (48%) had diagnostic levels (A1C≥6.5%). 51% tested were overweight and 18% obese by BMI measurement. Known Diabetes: 1,128 had RBG testing with a mean result of 225mg/dl. 803 had A1C testing, of which 67% had uncontrolled diabetes (A1C≥7.0%) and 21.5% had poorly controlled diabetes (A1C≥9.5%). 46% were overweight and 24% obese.

Cost in India to identify each likely new pre-diabetes or diabetes patient was only $13.61 and to identify each poorly controlled diabetes patient was $8.02.

Conclusions: Using POC RBG and A1C tests was effective and efficient to screen for diabetes and identify poorly controlled diabetes in a community-based setting. The high percentage of uncontrolled diabetes shows the need for frequent testing and teaching platforms like this one to reinforce proper diabetes management. On-site physician intervention could then be effective to develop care plans and provide targeted teaching and follow up.

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