Much of the world is facing a growing diabetes burden, with the majority of people with diabetes now living in low- and middle-income settings. More than half of those individuals do not know that they have diabetes and thus cannot take action to reduce their risk of future complications, including cardiovascular disease. There is an urgent need for more accessible and affordable screening strategies and devices.
This article outlines and analyzes desirable features of point-of-care (POC) screening devices to be designed specifically for low-resource settings and makes the case for an adaptable set of diabetes screening technologies and algorithms to apply in different contexts depending on the level of resources available.
In addition to potential cost savings and the general advantages of POC testing for patients and providers, the elimination of fasting as a requirement for diabetes screening is likely to be critical. Nonfasting tests would allow opportunistic screening and thus be more amenable to low-resource settings, where visits to health care providers are rare and loss to follow-up is high. A variety of novel methods for diabetes screening in low-resource settings are being studied, including low-cost, POC-compatible HbA1c (blood glycated hemoglobin) readers, noninvasive advanced glycation end-product readers, devices that noninvasively measure sudomotor function (and by inference diabetes risk), and POC assays for glycated albumin, fructosamine, and other shorter-term averaging indicators that can serve as alternatives to HbA1c for populations in which this test is not appropriate. Complementary to test development will be investments in systems strengthening and work with communities to support healthy behaviors, for diabetes screening as well as prevention and management.