Diabetes Screening Interventions in Low- and Middle- Income Countries: A Systematic Review

Abstract Background The rising prevalence of type 2 diabetes (T2DM) in low- and middle-income countries (LMICs) places significant strain on already fragile health systems, particularly given that diagnosis is frequently delayed until after serious complications have arisen. Screening interventions can ensure early detection of undiagnosed diabetes hence improve treatment outcomes. Evidence on how successful screening interventions could be designed, implemented, and linked to ongoing care in these resource-limited settings remains fragmented. There is also limited evidence that systematically describes and characterises screening interventions. This study aims to identify and categorise screening interventions for type 2 diabetes (T2DM) in LMICs and to describe their characteristics, implementation outcomes, and contextual factors. Method We conducted a systematic review of studies evaluating T2DM screening interventions in adult populations (≥ 18 years) within LMICs. We searched CINAHL, Embase, MEDLINE, PsycInfo, PubMed, and Scopus in March 2026. Two reviewers independently screened studies on Rayyan, extracted data and performed a narrative synthesis. The screening interventions were classified into various key components covering target population, screening test, screening intensity, screening technology/tool, diagnostic criteria, delivery agent/personnel, training component, screening location, geographical and health system setting, program integration and care cascade progression. Results From an initial 13,396 identified records, 19 included studies were conducted across 12 countries, with the majority from India (n = 9). Most of the reported screening interventions targeted the general population and were conducted mostly in urban areas (n = 8), within the community, by community health workers. Detection rates were higher for targeted screening approaches. Only three studies reported completion of the care cascade beyond screening. The use of existing health systems, task shifting to community health workers, and adoption of technology were cited as the main facilitators of successful implementation. Limited resources were reported as the main constraint in most studies. Conclusion T2DM screening interventions in LMICs are heterogeneous in design and setting. Integration into existing infrastructure, targeting at-risk groups, and task shifting as key facilitators of diabetes screening in LMICs. However, the care cascade revealed major gaps due poor linkage, loss to follow-up, and "screening only" designs, alongside scarce economic evidence. Future programmes should embed linkage-to-care, economic evaluation, and sustainability planning from the outset, prioritizing at-risk populations at the primary healthcare level.