Review written by IROAGANACHI.V.C., OD, Msc DIA

According to International Diabetes Federation, latest publication about 537 million adults (20 to 79) are living  with T2 diabetes, one in ten the number is predicted to go up to 643 million by 2030, and 783 million by 2045, over 4 in 5 (81%) adults with diabetes live in low and middle income countries. Base on estimations from various population distribution studies and analysis, it is projected that the prevalence of diabetes will increase in the coming years. It is therefore necessary we plan for a structured diabetes screening that targets patients populations with the most prevalent risk factors. For example dyslipidemia, obesity, hypertension, and abnormal anthropometric indices.

In some African community health centre are developed which includes mobile outreach programme guided by ministry of health agencies, to be able to reach out to people from all works of life. Conditions  for the diabetic screening is usually announced or published on media platforms i.e, radios stations, news paper announcements, sharing of printed informative fliers  etc. Patients are asked to fill criteria form outlining their  Age, ethnicity, body weight, family history of diabetes or gestational diabetes, CVD, hypertension and peripheral vascular disease. Signs or symptoms polyuria, polydipsia and polyphagia are recorded.

Afterwards  Physical screening are provided for all those that passed the electronic  or in person qualification criteria, patients documents are retrieved and handed to the community diabetes multi disciplinary outreach team to conduct various tests with accepted ranges as recommended by hospital local policy on diabetes screening popularly called an “outreach programme” A method used to screen and provide health advice for people at high risk of various health challenges not just diabetes. Capillary fasting blood glucose ( < 140mg/dl) is taken instead of FPG or HbA1c due to financial burden associated with later tests. electronic blood pressure devices are utilized and the mean results recorded, range (120/80mmhg to 140/90mmhg), total cholesterol range (< 200mg/dl), height and weight or BMI (< 30kg/m2), signs or symptoms of diabetes complication are recorded on site and documented.

The next phase includes screened patients with various diabetes risk factors outlined through initial screening. Patients are referred for more satisfactory examinations in private or government established community hospitals for run off test and final classification of patients to either pre-diabetes, diabetes or normal glucose tolerance, management or treatment are undertaken at this stage and maintained. The outreach programmes are mobile and organised periodically, which acts as a medium to get patients from the wider population who are at high risk of diabetes to avail for adequate medical treatment or management.

Limitation to this outreach model of screening; 

• Poor or unavailability of funtional media devices  for people in remote areas of the community to get informed about the programme to ensure fair participation.
• Limited materials for examination i.e test strips, bp apparatus, and others, normally screening stops when the materials get exhausted.
• Limited professional engagement or staffs leading to low counts of persons to be screened per day.
• People with other disease burden and economic priority other than presenting for the DM screening.
• Lost of faith in government or persons sponsoring outreach programme.

Ways that have worked for some practitioners to ensure people avail for the programmes.

• Prior to the screening stakeholders engage in community sensitization through radio talk shows on local stations, news papper publications, and printing of fliers, most fliers are sent to community heads or organisational heads for even distribution.
• Medical practitioners, philanthropist, government are engaged to get actively involved and seek for proper funding ahead.
• Providing accessible sites and adequate referral pathways. After screening patients receives quality management or treatment. It is important to note  that due to high level of poverty in the country  only 40% may finally receive effective treatment or management if diagnosed with diabetes or pre-diabetes, some may resort to herbal tea for blood sugar control and religion divinations for healing.

Having followed some trend for final screening of patients at high risk of diabetes in the hospital and organized outreach, most features adopted the American Diabetes Association recommendations and Word Health Organization diabetes risk factors variables ranges as their guidelines in their final screening and diagnoses of asymptomatic adults, pre-diabetes and diabetes.

Many African countries are yet to reach the desirable level of diabetes screening, this have contributed to the high prevalence of diabetes recorded in Africa and low income countries. Please if you can make freewill donation using the donation form, I am dedicated to diabetes survival and wellness that targets millions of people living with undiagnosed diabetes, which have left many with inhuman incapacitations.

Stakeholders all over the world may feel free to try the model i have explained and see what works best for them.