Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness

Tucker Reed; Sara Scott; Eshleen Grewal; Fatima Macavinta; Saania Tariq; David J T Campbell

doi:10.1016/j.jcjd.2024.03.008

Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness

Can J Diabetes. 2024 Apr 4:S1499-2671(24)00066-2. doi: 10.1016/j.jcjd.2024.03.008. Online ahead of print.

Authors

Tucker Reed¹, Sara Scott², Eshleen Grewal³, Fatima Macavinta⁴, Saania Tariq³, David J T Campbell⁵

Affiliations

¹ Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada.
² Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Calgary Drop-In Centre, Calgary, Alberta, Canada.
⁵ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: dcampbel@ucalgary.ca.

PMID: 38582226
DOI: 10.1016/j.jcjd.2024.03.008

Abstract

Objectives: The rising prevalence of type 2 diabetes (T2D) in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study, we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning healthcare services and public health initiatives.

Methods: Four screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care glycated hemoglobin (A1C) testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CanRisk survey scores were used to identify the pre-test probability of diabetes.

Results: The mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including: housing and financial issues (n=53), interpersonal and family issues (n=35), and health or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia.

Conclusions: The high rate of undiagnosed prediabetes and diabetes among people experiencing homelessness reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.

Keywords: A1C; diabetes; diabetes screening; diabète; dépistage du diabète; homelessness; itinérance; point de service; point of care; prediabetes; prédiabète.