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May 27, 2022
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Diabetes screening alongside COVID-19 testing feasible in low-income Latinx community

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Integrating rapid HbA1c testing within a COVID-19 testing program helped identify previously undiagnosed adults with prediabetes and diabetes in a low-income Latinx population, according to study findings.

In a health improvement study conducted at a COVID-19 testing site in a predominantly Latinx neighborhood in San Francisco, researchers offered HbA1c testing to people who underwent testing for COVID-19 from Aug. 1 to Oct. 5, 2021. People who elected to undergo both COVID-19 and HbA1c testing were highly satisfied with their experience, and most staff members said performing both tests at the same time was feasible.

Carina Marquez, MD, MPH
Marquez is an assistant professor of medicine in the division of HIV, infectious diseases and global medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.

“Integrating rapid HbA1c testing at a community COVID-19 testing site was acceptable, feasible and identified many persons with undiagnosed prediabetes and diabetes who were mostly low-income, Latinx and not engaged in primary care services,” Carina Marquez, MD, MPH, assistant professor of medicine in the division of HIV, infectious diseases and global medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, told Healio. “Integrating diabetes screening paired with linkage to care and community trust has the potential to address health disparities in diabetes and other chronic disease.”

Multi-disease screening at COVID-19 testing sites

Marquez and colleagues conducted the HbA1c rapid testing and HIV testing at a COVID-19 testing site located at a transportation hub in the Mission District of San Francisco. Beginning on Aug. 1, 2021, people who had a COVID-19 test performed could also undergo HbA1c testing. There were 6,631 adults tested for COVID-19 and/or diabetes during the study period, of whom 65.6% were Latinx or American Indian from Central or South America, and 68% had an annual household income of less than $50,000 per year.

“This work was done as part of the Unidos en Salud community-academic partnership between University of California, San Francisco, and the San Francisco Latino Task Force for COVID-19,” Marquez said. “We had spent 1 year working on implementing community-centered solutions to address COVID-19 health disparities in the Latinx community and wanted to address the many other disparities we were seeing. Together, we decided to integrate diabetes screening with rapid HbA1c tests and HIV testing, as these were two diseases that disproportionately impact our community.”

Those who were found to have prediabetes or diabetes were provided brief health education and linkage to primary care by a Spanish-speaking bilingual community health worker. Researchers analyzed the proportion of people with newly diagnosed diabetes, the proportion who received diabetes-related counseling, and linkage to primary care in those with an HbA1c of 6.5% or higher. Acceptability of multi-disease testing among clients and feasibility among the testing site’s staff were analyzed.

The study findings were published in JAMA Network Open.

High satisfaction, feasibility with diabetes screening

Of all people tested during the study period, 13.9% elected to undergo HbA1c testing. Of those tested for diabetes, 47.1% had little or no diabetes-specific knowledge, 30.1% had previously been tested for diabetes and 6.4% were previously diagnosed with diabetes.

Of those tested for HbA1c, 53.9% had a normal HbA1c of less than 5.7%, 33.9% had prediabetes with an HbA1c between 5.7% and 6.49%, and 12.2% had diabetes with an HbA1c of 6.5% or higher. Latinx adults accounted for 84.4% of those with prediabetes and 85.8% of those with diabetes. Less than half of those with diabetes said they had previously been tested or had a prior diabetes diagnosis.

Of those testing positive for diabetes, 82.7% were reached by community health worker within 24 hours of their result. The diagnosis was new for 53.3% of the diabetes group, while 35% had a prior diagnosis and were engaged in care and 11.7% had a prior diagnosis but were not engaged in care.

The multi-disease rapid testing program was acceptable to nearly all clients, with 98% saying they were highly satisfied or satisfied with their visit and 95.7% saying they would return for future services if offered. Of 21 staff members surveyed, 19 said it was feasible to integrate HbA1c testing into other existing COVID-19 testing programs.

“Further implementation of science research and programs are needed to optimize linkage to health care and explore how community testing sites can continue to support longitudinal engagement in care,” Marquez said. “We should continue to think outside the box about new models of easily accessible community-based care for diabetes and other chronic diseases.”

For more information:

Carina Marquez, MD, MPH, can be reached at carina.marquez@ucsf.edu.