The findings of our study shed light on various aspects of diabetes awareness, risk assessment, and subsequent diagnostic processes within the community pharmacy setting. The findings revealed a diverse demographic profile among the recruited participants, with a slightly higher representation of females. Through comprehensive assessments utilising tools such as the Diabetes Knowledge Questionnaire (DKQ), the study elucidated significant differences in diabetes knowledge across various subgroups. Notably, participants on BP medication exhibited higher knowledge scores in the diabetes knowledge domain, while those engaging in regular physical activity demonstrated greater awareness of diabetes complications. Moreover, individuals previously informed of high blood glucose levels exhibited higher scores in general knowledge and lifestyle domains, underscoring the importance of early diagnosis and education in diabetes management. However, despite the observed variations in knowledge scores, no significant differences were noted in overall DKQ scores or its component scores, except among participants previously diagnosed with high blood glucose levels.
By leveraging pharmacy-led screening initiatives, this paper aimed to enhance early detection and prevention efforts among eligible adults in rural pharmacies across Western NSW Local Health District (LHD). Through the administration of the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) tool and the performance of HBA1C and random blood glucose testing, this research sought to identify individuals at risk of T2DM and facilitate timely referrals for further testing and management. Our results revealed a concerning prevalence of individuals at high risk of developing T2DM, with 76.8% of participants classified as high risk based on their AUSDRISK scores. These findings highlight the need for targeted interventions to address knowledge gaps and enhance overall diabetes awareness aimed at risk reduction and early intervention.
Tight glycaemic control has been shown to delay diabetes-related complications37–39, emphasizing the importance of timely detection and management. In rural settings like Bathurst, where access to healthcare services is limited and specialist endocrinology services are limited, community-based screening initiatives play a vital role in bridging the gap in healthcare access. The outcomes of the HBA1C and RBG testing further underscore the importance of opportunistic screening in identifying individuals with undiagnosed diabetes, especially in rural areas where GP appointments are not readily available40, 41. With over half of the participants with elevated blood glucose levels indicative of diabetes or pre-diabetes, timely referrals to medical practitioners for further testing and management are imperative.
Diabetes knowledge is of paramount importance in rural areas due to various factors that distinguish these regions from urban settings. Understanding and addressing diabetes in rural communities is crucial for public health, and a well-informed community can contribute significantly to the prevention, management, and overall well-being of individuals affected by diabetes42, 43. Diabetes knowledge becomes a critical asset in these communities as it enables 44, 45. Empowering rural populations with knowledge about diabetes is particularly significant for encouraging preventive practices, including healthy dietary choices and regular physical activity. Tailoring diabetes education to the cultural context of rural communities ensures that interventions align with local practices, fostering greater acceptance and integration of diabetes management strategies.
In addition to promoting risk awareness and early detection, diabetes knowledge supports self-management and empowerment, especially crucial in areas with limited healthcare professionals46, 47. By dispelling myths and reducing stigma, diabetes knowledge initiatives contribute to improved mental health and well-being. Creating a supportive environment through community engagement and shared commitment to health allows for mutual support among individuals with diabetes in rural areas48, 49. Lastly, by understanding the economic implications of diabetes and promoting informed decision-making, diabetes knowledge can play a vital role in alleviating the economic burden associated with diabetes-related complications in rural communities. In essence, diabetes knowledge emerges as a key tool for enhancing health outcomes, resilience, and overall well-being in rural populations. Targeted education programs, community engagement, and culturally relevant initiatives are essential components in addressing the unique challenges occasioned by diabetes in rural communities.
The Australian Type 2 Diabetes Risk Assessment Tool (AUDSRISK) holds significant importance in the diagnosis and management of diabetes in rural Australia. In this study, it identified the highest number of the participants as being at moderate to high risk of developing diabetes. Its utility stems from several key factors. Firstly, AUDSRISK costs nothing and enables early detection of individuals at risk of developing T2DM, a critical function in regions where access to healthcare services may be limited. By assessing various risk factors such as age, gender, family history, and lifestyle habits, healthcare providers can intervene proactively, potentially preventing or delaying the onset of diabetes. Furthermore, AUDSRISK facilitates personalized preventive interventions tailored to individual risk profiles34, 50. For instance, individuals identified as high risk may benefit from lifestyle modification programs, nutritional counselling, or regular monitoring to prevent or delay the progression to diabetes. Also, by completing the AUDSRISK participants are empowered by raising awareness about their diabetes risk and providing them with actionable information to make informed decisions about their health. By engaging patients early in their care, healthcare providers foster a sense of ownership and accountability, leading to better long-term health outcomes. Additionally, AUDSRISK empowers patients by raising awareness about their diabetes risk and providing them with actionable information to make informed decisions about their health. By engaging patients early in their care, healthcare providers foster a sense of ownership and accountability, leading to better long-term health outcomes.
The decision to refer both moderate and high-risk individuals for testing demonstrates a proactive approach to healthcare delivery and disease management. By identifying individuals at risk and facilitating further testing, healthcare providers can intervene early, offering support, education, and appropriate interventions to mitigate the progression of T2DM or even prevent its onset altogether. Frequent follow-up is a critical component of diabetes care as it helps monitor long-term outcomes, risk assessment, identify trends and patterns and quality of life amongst others51–53. Many studies often assess diabetes knowledge in their target population with varying rates of referral compliance. A systematic review and meta-analysis of diabetes screening conducted in community pharmacies concluded that although screening identified a significant number of individuals at a high risk of having diabetes, many of these individuals did not attend a follow-up appointment with their HCP54. In this study, participants were followed-up after referral to ensure that they met with their GP for confirmatory tests and management.
Strengths and limitations
This study demonstrates several strengths, including its community-centred approach that involves consultation with local pharmacies and targets rural areas with limited access to healthcare services. Through the collaboration of researchers and pharmacy staff, the study adopts a multidisciplinary approach to addressing public health challenges, facilitating knowledge sharing and understanding of the challenges of rural diabetes management. Ethical considerations, such as obtaining approvals and informed consent, underscore a commitment to protecting participants' rights and ensuring research integrity.
However, the study faces several limitations, including sample size reduction and attrition, which may compromise sample representativeness and statistical power over timeSelection bias introduced by recruiting participants within pharmacy settings may limit the generalizability of findings. The individuals who visit pharmacies may be sick or seeking healthcare services and hence may be overrepresented in the sample. Moreover, low attendance rates for follow-up appointments highlight challenges in effective follow-up care, exacerbated by access barriers, patient reluctance, and healthcare system limitations. Reliance on self-reported measures for data collection may introduce response bias, while resource constraints faced by participating pharmacies, such as staff shortages and financial difficulties, underscore operational challenges that can affect program implementation and sustainability.