Black Barbershops a Useful Venue for Diabetes Screening, Too

Barbershop-based diabetes screening identified high rates of prediabetes among black men, researchers said, as well as more cases of overt diabetes than might be expected.

Out of 290 black men tested during their barbershop visits, about 28% met the criteria for prediabetes -- i.e., HbA1c between 5.7% and 6.4%, reported David Lee, MD, of the New York University School of Medicine in New York City, and colleagues, in a JAMA Internal Medicine research letter.

Another 9% had an HbA1c of 6.5% or higher, meeting the criteria for diabetes. A few individuals even had HbA1c levels about 7.5%; the highest recorded level was 7.8%.

This prevalence of undiagnosed diabetes is nearly three times the estimated prevalence of undiagnosed diabetes in the New York City area.

Not surprisingly, the majority with A1c values above 6.5% also had obesity.

"We also found that barbers were important health advocates; although we do not have exact numbers, some customers (who initially declined testing) agreed after encouragement from their barber," Lee's group highlighted.

This isn't the first barbershop-based health intervention to prove successful. A previous trial in the Los Angeles area found very similar results with a hypertension-management program delivered in black-owned barbershops. That particular intervention found customers had an average systolic blood pressure reduction of 27.0 mmHg six months after visiting a barber who encouraged them to meet on-site with a specialty pharmacist.

For this analysis, 895 male customers from eight black-owned barbershops in Brooklyn were asked to undergo on-site, HbA1c testing with the A1cNow test. This particular test yields results within five minutes with 93% accuracy. All men screened were English-speaking black men over the age of 18, without a history of diabetes, sickle cell disease, or recent blood loss.

Notably, about two-thirds of men approached for screening refused it. Most said it was because they already underwent screening by their healthcare provider and knew their health status. Other common reasons for refusing the screening was because they thought they were healthy, didn't have time, weren't interested, or simply didn't want to know their results. Several other men refused testing because they were scared of needles.

But along with this convenient, point-of-care HbA1c testing, subsequent confirmatory testing is also necessary to verify diabetes status, Lee and colleagues noted. Current guidelines from the American Diabetes Association state that "[a]lthough point-of-care A1C assays may be NGSP [National Glycohemoglobin Standardization Program] certified or U.S. Food and Drug Administration approved for diagnosis, proficiency testing is not always mandated for performing the test."

"Therefore, point-of-care assays approved for diagnostic purposes should only be considered in settings licensed to perform moderate-to-high complexity tests," the ADA guidelines point out, adding that this type of testing is better applied to routine glucose monitoring rather than initial diagnosis.

Given the high rate of resistance from the customers for this initial screening, getting them to agree to confirmatory testing may be an added hurdle for this intervention.

Despite these limitations, Lee and colleagues said the barbershop strategy "may play a role in the timely diagnosis of diabetes and may help to identify black men who need appropriate care for their newly diagnosed diabetes."

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