- Diabetes meets the criteria for population-wide screening because of the large burden, the understanding of its natural history, the long latency period, and the availability of cost-effective treatments. However, several challenges exist for population-wide screening.
- Having a reliable, high-performance, convenient, low-cost screening test that can be applied universally is needed. Point of care (POC) capillary blood screening has many advantages─ is simple and reliable, and could easily be applied to low and middle income countries (LMICs).1
- Although capillary blood glucose is a feasible alternative for screening of diabetes and prediabetes in epidemiological studies in developing countries substantial overestimation (50%) occurs with capillary blood glucose.1 A South Indian Study has reported the mean fasting capillary blood glucose of 122 mg/dl vs 115 for venous plasma glucose measurements with even greater difference for post 2-hr prandial values (203 vs 176 mg/dl). Based on the ADA (American Diabetic Association) fasting criteria, 32% had diabetes by capillary blood vs versus 21% by venous blood measurement.2
- Much research is available that suggests a policy focused on early identification of diabetes may be worth serious consideration. However, it will be challenging for health systems worldwide, especially in LMICs, to carry out screening procedures and then manage the potentially large burden of new cases.
- The time has come for LMICs, like China and India to invest more in health care and pursue a policy of active identification of people with diabetes and implement innovative management strategies.1
1. Narayan KM, Chan J, Mohan V. Early Identification of Type 2 Diabetes: Policy should be aligned with health systems strengthening. Diabetes Care. Jan 2011;34(1):244-246.
2. Priya M, Mohan Anjana R, Pradeepa R, et al. Comparison of capillary whole blood versus venous plasma glucose estimations in screening for diabetes mellitus in epidemiological studies in developing countries. Diabetes Technol Ther. May 2011;13(5):586-591.