Diabetes screening in India may be ineffective: study

Large-scale screening for diabetes in India using currently available survey and glucometer based screening tools may be ineffective, a new study by an India-American scientist has claimed.
The predictions of this simulation, conducted by Sanjay Basu of Stanford University and colleagues, suggest that large numbers of false positive results would waste financial resources, and that focusing on symptom-based screening and on improvements to diabetes treatment might better serve India's population.
Diabetes is becoming increasingly common, particularly in rapidly developing countries like India, but most people with diabetes are unaware that they have the condition, researchers said.
Researchers developed a microsimulation model (a computer model that operates at the level of individuals) to investigate the implications of using alternative screening instruments to identify people with undetected diabetes across India.

"Depending on which approach was used for screening, between 158 million and 306 million of the 567 million Indians eligible for screening would be referred for confirmatory testing," researchers said.
However, between 126 million and 273 million of these high-risk individuals would be false positives; only between 26 million and 37 million would meet the international diagnostic criteria for diabetes, they said.

The researchers estimate that the cost per case found would vary from USD 5.28 (for random glucose screening) to USD 17.06 (for a survey-based screening instrument).
Finally, they estimate that the total cost for screening the eligible population would be between USD 169 and USD 567 million.

The findings of poor test specificity are consistent with results from small, regional trials in India, researchers said.
Here, study limitations include the uncertainty of modelling a large, diverse population and of forecasting costs.
"Improving instruments to reduce false positive screens, preparing the health system for very substantial confirmatory testing demands, and identifying how to deliver efficacious treatment, are three priority areas that require urgent attention before rapidly-developing countries implement large-scale community-based diabetes screening programs," researchers said.
The study was published in the journal PLOS Medicine.