An Indian American scientist Sanjay Basu from Stanford University and his team has found that widespread diabetes screening in India is ineffective and glucometer-based screening tools are unlikely to meet effectiveness criteria.

For the new study, the researchers developed a micro-simulation 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.

They found out that:

  • Between 158 million and 306 million of the 567 million Indians eligible for screening would be referred for confirmatory testing, depending on which approach was used for screening.
  • Between 126million 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
  • The ratio of false positives to true positives varied from 3.9 (when using random glucose screening) to 8.2 (when using a survey-based screening instrument) in this model.

The researchers estimate that the cost per case found would vary from $5.28 (Rs.336) for random glucose screening) to $17.06 (Rs.1087) for a survey-based screening instrument. They also estimate that the total cost for screening the eligible population would be around $169 – $567 million.

Limitations of this study include the uncertainty of modelling a large, diverse population and of forecasting costs. But, the findings of poor test specificity are consistent with results from small, regional trials in India.

The authors of the study suggest,


“Focusing on symptom-based screening and on improvements to diabetes treatment might better serve India’s population.”

Sanjay Basu’s award of $100,000, George Rosenkranz Prize for Health Care Research in Developing Countries in 2014, has helped fund this large-scale data collection project in India to improve Type-2 diabetes screening in the country, leading to better treatment and detection of the disease.

The study has been published in the journal PLOS Medicine.



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