Designing and implementing a prediabetes screening in community pharmacies and online prevention program: findings from the PREDICT study

Diabetes is a major public health challenge, driving increased morbidity and healthcare costs. Early detection of prediabetes is essential to halt or reverse its progression to diabetes and its associated complications. Community pharmacy services offer untapped potential for health promotion and early chronic disease detection among asymptomatic adults. Guided by the first three phases of the EPIS framework (Exploration, Preparation, and Implementation), this paper describes the design and implementation of a culturally appropriate community pharmacy-based prediabetes screening and online diabetes prevention service. This prospective multicentre mixed-method implementation study, conducted between, employed a three-phase approach to optimize pharmacy service delivery and integration. The Exploration phase involved stakeholder analysis of community members, pharmacists, and physicians, using a survey and semi-structured interviews, to inform service design and implementation strategies. In the Preparation phase, a culturally appropriate pharmacy-based prediabetes screening and prevention service was developed. This process involved conducting focus groups, translating and culturally adapting the Diabetes Prevention Program, developing supporting resources, site selection, and training participating pharmacists. The Implementation phase engaged 15 community pharmacies in the United Arab Emirates. Trained pharmacists delivered evidence-based screening protocols to assess glycemic status using point-of-care HbA1c testing, lifestyle factors, and health behaviors. Participants with identified prediabetes were systematically referred to the online prevention program. A total of 1611 individuals participated in this study. In the Exploration phase, a survey of community members (n=279) revealed high acceptance of pharmacy-based screening (84%) with 59% considering pharmacies suitable locations. During the Implementation phase, pharmacists successfully screened 1320 participants (62.2% male; mean age 41.0±9.7 years). Of those screened, 24.3% (n=321) were identified with previously undetected prediabetes and 12.0% (n=159) had HbA1c levels consistent with diabetes. The pharmacy-based screening functioned as an entry point for the online prevention program where diabetes educators successfully delivered culturally appropriate personalized sessions promoting adoption of healthier lifestyle behaviors. The participants screening stage lasted between two to four months per pharmacy, and the average duration of the prevention program was six months. From a public health perspective, pharmacy-based screening offers a valuable opportunity to increase access to early prediabetes detection and diabetes prevention interventions. The PREDICT study provides a replicable framework for developing and implementing pharmacy-based cardiometabolic screening services that can be adapted across diverse healthcare contexts.