Better Diabetes Screening – and Faster Access to Care

Peel Region has some of the highest rates of type 2 diabetes in Ontario – in some neighbourhoods, more than double the provincial average. This is because the area is home to one of Canada’s largest South Asian communities – a population that faces a higher and earlier risk of the disease due to genetic and metabolic factors.

Yet many residents remain undiagnosed.

When researchers led by Ghazal Fazli, an assistant professor in the department of geography, geomatics and environment at U of T Mississauga, offered community-based screening at two wellness fairs, about one in four people tested were found to have diabetes or pre-diabetes.

Undetected diabetes can quietly damage blood vessels and organs for years before symptoms appear, increasing the risk of heart disease, kidney failure, blindness and limb amputation. But when elevated blood sugar is identified early, progression to full-blown disease can often be delayed – or even prevented – through changes in diet, exercise and medical care.

The challenge is access. In Peel, about one in six residents does not have a primary care provider, and younger adults – who are not routinely screened because they aren’t considered high risk and may rarely see a doctor – are especially likely to fall through the cracks. Fazli’s own research has found that young people with pre-diabetes can progress to diabetes within as little as five years. “It’s really scary,” she says.

Working with community partners, Fazli and her team devised a solution. The first phase involved diabetes prevention and wellness fairs – with Zumba classes, cooking demonstrations and face painting to make the events welcoming and stigma-free.

The team’s mantra was “detect, educate, connect”: identify at-risk people in the community through on-the-spot testing, teach them how to protect their health, and sign them up with a primary care provider if they didn’t already have one.

At each fair, visitors were invited to complete a questionnaire covering age, diet and exercise, as well as experiences of racism, housing and food insecurity.

They were then offered a blood sugar test that measured average blood glucose levels over the previous three months. Usually, this test requires a blood draw and a days-long wait for results, but Fazli’s team used a compact analyzer that required only a finger prick and delivered results within three minutes.

Between the two wellness fairs – one in Mississauga and the other in Brampton – the researchers screened more than 200 people. Twenty-five per cent were found to have diabetes or pre-diabetes. In other words, dozens learned for the first time that they had a serious health condition.

A dietitian was stationed at each booth to explain how changes in diet and exercise could improve blood sugar levels. But screening and education alone weren’t enough. People with diabetes – or at risk of developing it – need primary care. So, Fazli’s team had arranged with six local clinics to accept new patients and help people register with doctors. When the researchers followed up, they discovered that every single person they had connected to a family doctor had gone for the recommended appointment.

Diabetes is not only a private health issue; it also carries a significant social and economic burden. According to Diabetes Canada, the direct cost to Ontario’s health system in 2024 was $2.2 billion. Identifying at-risk people earlier and educating them about prevention and management could yield significant savings – fewer ER visits, surgeries and long-term complications.

Phase 1 showed that the approach was both feasible and culturally acceptable. For Phase 2, launching in spring 2027, Fazli hopes to reach more at-risk residents in a wider range of settings – especially those unlikely to seek screening on their own. “We need to go into the community and not have the community come to us,” she says.

One new idea will involve pop-up screening – in community centres, faith-based centres, workplaces and other venues. Fazli points to pop-up diabetes screening in barbershops in New York, which successfully engaged Black men who had previously been overlooked.

Another idea is mobile testing – in the form of a bus. Fazli sees this as potentially broader: “If our bus is going into the community, it’s also going to do mental health, cancer screening – it might even do COVID testing and vaccines.”

Above all, the team wants to understand what works, for whom, and under what circumstances. “Our status quo, our current practice, is not slowing down the diabetes epidemic,” Fazli says.