title: A pragmatic and scalable strategy using mobile technology to promote sustained lifestyle changes to prevent type 2 diabetes in India-Outcome of screening.
abstract: OBJECTIVE
  We describe a two-step screening approach using non-invasive risk assessment and glycated hemoglobin (HbA1c) to identify participants for a diabetes prevention trial.
  
  
  METHODS
  A total of 6030 non-diabetic persons of 35-55 years were screened using risk assessment for diabetes. Those with three or more risk factors were screened using point of care HbA1c test. For this study, participants in HbA1c categories of 6.0% (42.1 mmol/mol)-6.4% (46.4 mmol/mol) were selected and their characteristics were analyzed.
  
  
  RESULTS
  Among 6030 persons, 2835 (47%) had three or more risk factors for diabetes. Among those screened with HbA1c, 43.2% (1225) had HbA1c values of <6.0% (42.1 mmol/mol), 46.8% (1327) had HbA1c values between 6.0% (42.1 mmol/mol) and ≤ 6.4% (46.4 mmol/mol) and 10% (283) had undiagnosed diabetes with ≥6.5% (47.5 mmol/mol). Positive family history was present in 53.2%, 81.7% were obese and 14.8% were overweight.
  
  
  CONCLUSIONS
  Opportunistic screening using a two-step approach: diabetes risk profile and HbA1c measurement detected a large percentage of individuals with prediabetes. Prediabetic persons recruited to the trial had higher percentage of obesity and presence of positive family history than those who had lower HbA1c values. Outcomes from this trial will enable comparisons with the previous prevention studies that used blood glucose levels as the screening criteria.
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Susairaj
authors.initials: S
authors.lastname: Priscilla
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Nanditha
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Simon
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Satheesh
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Sathish
authors.initials: S
authors.lastname: Kumar
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Ananth Samith
authors.initials: AS
authors.lastname: Shetty
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India.
authors.forename: Chamukuttan
authors.initials: C
authors.lastname: Snehalatha
authors.affiliation: Faculties of Medicine and Engineering, Imperial College, London, UK.
authors.forename: Desmond G
authors.initials: DG
authors.lastname: Johnston
authors.affiliation: Faculties of Medicine and Engineering, Imperial College, London, UK.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Godsland
authors.affiliation: Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai 600008, India. Electronic address: ramachandran@vsnl.com.
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
mesh_terms: D000328:Adult; D015992:Body Mass Index; D040421:Cell Phone; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D018579:Patient Selection; D011236:Prediabetic State / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D017216:Telemedicine
chemical_list: D006442:Glycated Hemoglobin
keywords: HbA1c; Primary prevention; Screening; Short messaging service