Mixed
Large-scale community-based screening for type 2 diabetes using survey-based risk scores or random glucose testing in India generates a massive burden of false positives (ratios of 3.9 to 8.2 false positives per true positive), creating significant health system costs without proportional health benefits.
For policymakers and health system administrators in India: Do not implement large-scale community screening using current survey-based tools or random glucose tests without ensuring robust, affordable confirmatory testing infrastructure. The current approaches generate massive numbers of false positives, overwhelming the health system with costs ranging from $169 million to $567 million, with little gain in early detection compared to direct fasting glucose testing.
Of the 567 million Indians eligible for screening, depending on which of four screening approaches is utilized, between 158 and 306 million would be expected to screen as 'high risk' for type 2 diabetes, and be referred for confirmatory testing. Between 26 million and 37 million of these people would be expected to meet international diagnostic criteria for diabetes, but between 126 million and 273 million would be 'false positives.'
Why this rating
Based on a validated microsimulation model using data from 58 studies, though limited by the model's reliance on published cohorts that may not capture the poorest/rural areas.
Source
The Health System and Population Health Implications of Large-Scale Diabetes Screening in India: A Microsimulation Model of Alternative Approaches
Sanjay Basu et al. · PLoS Medicine · 2015
DOI 10.1371/journal.pmed.1001827
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