Detection of prediabetes and undiagnosed type 2 diabetes in underserved communities using community pharmacy point-of-care testing: A prospective feasibility study.

AIMS: Early detection of type 2 diabetes (T2D) and prediabetes is critical to reduce disease burden, yet disadvantaged populations often remain undiagnosed. We assessed a pharmacy-based pathway using verified point-of-care HbA1c testing to identify prediabetes and enable engagement with a digital prevention programme and established the detection rates for undiagnosed T2D.

METHODS

We conducted a prospective feasibility study across 16 community pharmacies in NHS Tayside, Scotland (Feb 2024-Jan 2025). Adults at high risk of T2D, identified using the Diabetes UK 'Know Your Risk' tool, were offered HbA1c testing. Participants with HbA1c 42-47 mmol/mol (6.0-6.4%) were referred directly to a digital diabetes prevention programme (DDP); those with HbA1c ≥48 mmol/mol (6.5%) were advised to attend their GP. Comparator data were drawn from GP patients identified for engagement with the same DPP.

RESULTS

Of 499 pharmacy participants, 75 (15%) had prediabetes; 38 (51%) enrolled in DPP. Nineteen (4%) had HbA1c ≥48 mmol/mol (6.5%); 17 attended GP. Compared with GP-identified prediabetes (951 patients; 212 enrolled, 32%), pharmacy-based recruitment doubled DDP engagement (RR 2.08, 95% CI 1.61-2.67). Pharmacy recruited relatively younger participants from more deprived backgrounds (63% SIMD 1-2 vs. 33% in GP cohort).

CONCLUSION

Community pharmacies provided effective, equitable access to HbA1c testing and diabetes prevention, identifying individuals with prediabetes and undiagnosed T2D being missed by current pathways and doubling engagement of this underserved population with DPP. Pharmacy-based screening offers a scalable opportunity to reduce health inequalities and expand primary care capacity.