March 24, 2026 · Executive Brief

Diabetes Alert Day 2026

Turn risk awareness into appropriate testing, diagnosis, prevention support, and sustained care.

Written byGreg WahlstromMBAHCMPresident and Chief Executive Officer, The Healthcare ExecutiveOctober 2026 28 min read

The 2026 leadership signal

A wake-up call needs a reachable next step.

Diabetes risk tools can start a conversation but cannot distinguish type, establish a diagnosis, or replace laboratory testing and clinical assessment.

Executives should connect risk awareness with appropriate testing, clear result communication, diabetes prevention services for eligible people, and timely support for all forms of diabetes.

Audit one population from risk identification through completed testing, diagnostic disposition, and the first prevention or treatment connection.

U.S. burden

40 million+

The American Diabetes Association reported in 2026 that more than 40 million Americans were living with diabetes.

Unaware

1 in 4

The ADA reported that 1 in 4 U.S. adults with diabetes did not know they had it.

Prediabetes

115 million+

The ADA reported that more than 115 million people in the United States were living with prediabetes.

Figures are summarized from the authoritative sources linked below. Definitions and denominators should be read with each source.

Executive opening

A risk alert is only as strong as the step that follows it

Diabetes Alert Day asks people to learn their risk. For a health system, the harder question is what happens after someone learns it. Risk awareness creates value only when testing is reachable, results are explained and eligible people are connected to prevention. Recent studies show that each of those steps can fail on its own, and that some promising detection routes sit outside the clinic.^[1]^[3]

Community pharmacies are a clear example. In a Scottish feasibility study across 16 pharmacies, point-of-care HbA1c testing found prediabetes in 15% of 499 high-risk adults.^[1] Of the people with prediabetes, 51% enrolled in a digital prevention program.^[1] In rural New South Wales, by contrast, only 15% of people referred from pharmacy screening attended follow-up testing with a general practitioner.^[3] The same entry point produced very different follow-through depending on how the next step was built.

Eligibility rules matter as much as venues. Among U.S. young adults aged 18 to 34 with prediabetes, one in three (32.7%) would not have qualified for screening under current American Diabetes Association criteria.^[4] A system that relies only on criteria-triggered testing will therefore miss a meaningful share of people who could benefit from early prevention.^[4]

This brief adds the evidence behind the live page’s route, dashboard and plan. It examines the burden of undetected dysglycemia, the points where screening fails to become diagnosis or enrollment, and how access and equity shape those losses. It also looks at the people who carry each handoff and at how leaders can communicate risk in ways that earn a response. The executive question throughout is simple. Does a positive risk signal reliably reach a confirmed result and a program that a person actually starts?

Executive angle

This observance gives healthcare executives an opportunity to improve early detection of prediabetes and undiagnosed diabetes by strengthening the closed-loop pathway that connects community and pharmacy risk testing to confirmed results, prevention program enrollment and sustained engagement.

Questions for the executive team

Which adults in our population fall outside current screening criteria, and how many of them have never had an HbA1c test?
When a community or pharmacy partner finds an abnormal result, who receives it, and what share of those people complete confirmatory testing?
What share of people with confirmed prediabetes are offered, enroll in and attend a diabetes prevention program, and where does the cohort thin?
Which C-suite leader and board committee own the risk-to-prevention pathway, and how often do they review completion rather than screening volume?

How do testing, follow-up and enrollment differ by age, deprivation, language, insurance and neighborhood in our data?
Do pharmacists, educators, coaches and navigators have defined referral destinations, protected time and visibility into whether the person arrived?
What will we measure at 30, 60 and 90 days to show that one detection handoff has become more reliable?

Current evidence

What the research says about undetected prediabetes and its reach

Undetected dysglycemia is common wherever systems look for it. In 15 community pharmacies in the United Arab Emirates, trained pharmacists screened 1,320 adults with point-of-care HbA1c testing.^[2] Of those screened, 24.3% had previously undetected prediabetes and 12.0% had HbA1c levels consistent with diabetes.^[2] The service was designed for early detection among asymptomatic adults, not patients presenting with complaints.^[2] For a health system, that is a reminder that the people most in need of a test may never book a visit to ask for one.

High-risk families carry a concentrated burden. In a cross-sectional study of 1,029 first-degree relatives of people with type 2 diabetes, 39.1% had prediabetes and 9.2% had undiagnosed diabetes under a single diagnostic criterion.^[5] The test chosen changed the answer. Prediabetes prevalence was 18.4% by fasting plasma glucose, 18.0% by the two-hour glucose tolerance test and 30.9% by HbA1c.^[5] The authors found that fasting glucose performed worst and judged HbA1c a feasible tool for large-scale screening in high-risk groups.^[5]

Prediabetes is not a neutral waiting state. In a Greek outpatient cohort of 160 adults with prediabetes, 27 (16.9%) already had distal symmetrical polyneuropathy at baseline.^[11] Among the remaining 133 participants, 13 developed it over 24 months, an incidence of 9.8%.^[11] A meta-analysis of eight cross-sectional studies with 18,040 participants found higher odds of obstructive sleep apnea among people with prediabetes (odds ratio 2.78).^[12] In a Peruvian occupational cohort, screening-detected prediabetes was associated with a higher hazard of incident caries (adjusted hazard ratio 1.94).^[13]

For executives, these associations matter less as clinical detail than as operating signals. They show that early dysglycemia touches neurology, sleep, dental and occupational health services that rarely share a risk list.^[11]^[12]^[13] A detection effort that ends at the glucose result leaves those connections unused. One that shares the finding across services creates more chances for coordinated, earlier attention.

Age also changes what a positive result means. A review of prediabetes in children and adolescents notes that insulin sensitivity improves after puberty, so glucose metabolism normalizes spontaneously in most young people.^[10] For that reason, general population screening in youth is not recommended except in certain high-prevalence populations.^[10] The review also highlights the limits of applying adult diagnostic criteria to children, so pediatric and adult pathways need separate rules and separate measures.^[10] A single enterprise screening rule applied to every age group will produce misleading findings in both directions.

Figure 1

Detection works, but the next step decides whether it counts

Percent of the stated study group at each pathway step, as reported in each study. Values are copied from the cited studies [1], [2], [3], [4]; none is estimated.

Data note. These values come from different studies, countries, populations and denominators, so this is an indirect comparison; the bars show where detection pathways gain or lose people, not how one program outperforms another.

Limitation. Each value reflects its own setting and definition; the rural follow-up figure has no stated denominator in the abstract, and the screening-eligibility figure is a modeled application of criteria to survey data.

Figure data (5 rows)

Figure 1 data: Detection works, but the next step decides whether it counts
Measure	Value	Population, setting and year as reported	Source
Previously undetected prediabetes found at pharmacy screening	24.3%	321 of 1,320 adults screened in 15 community pharmacies, United Arab Emirates	[2]
Prediabetes found by pharmacy point-of-care HbA1c	15%	75 of 499 high-risk adults, 16 community pharmacies, NHS Tayside, Scotland, February 2024 to January 2025	[1]
Pharmacy-identified prediabetes enrolled in digital prevention	51%	38 of 75 participants with prediabetes, NHS Tayside, Scotland	[1]
Attended follow-up testing after pharmacy referral	15%	People referred to general practitioners after abnormal results, rural Western New South Wales pharmacy pilot, January to May 2023	[3]
Young adults with prediabetes not eligible for screening	32.7%	U.S. adults aged 18 to 34 with prediabetes, national survey data 2007 to 2016, under current American Diabetes Association criteria	[4]

A pharmacist walks a middle-aged South Asian man through a short paper diabetes risk questionnaire. — Illustrative image. Pharmacy point-of-care testing found previously undetected prediabetes in 24.3% of adults screened in one program.^[2]

Continuum of care

Where screening fails to become diagnosis and enrollment

The weakest link is usually the step after the first abnormal result. In the rural New South Wales pilot, everyone with an abnormal HbA1c or random glucose result was referred to a general practitioner and followed up by a clinician.^[3] Even so, only 15% attended follow-up testing, and 44% of those who attended were diagnosed with diabetes.^[3] The authors concluded that effective linkage to primary care remains a significant challenge.^[3] In operating terms, the referral was sent, but the loop was never closed. The pilot shows why a referral count is not a useful measure of success on its own.

Pathways that remove a handoff look different. In the Scottish study, pharmacies referred people with HbA1c of 42 to 47 mmol/mol directly to a digital prevention program rather than back to a general practice.^[1] Of 75 people with prediabetes, 38 (51%) enrolled.^[1] Of 19 people with HbA1c at or above 48 mmol/mol, 17 attended their general practitioner.^[1] Direct referral shortened the chain that a person had to complete alone. It also gave the pharmacy a clear destination for each result category, which reduced the judgment calls left to the person being screened.

The UAE program built the handoff into its design. Pharmacists systematically referred participants with identified prediabetes to an online prevention program, where diabetes educators delivered culturally appropriate, personalized sessions.^[2] The screening stage lasted two to four months per pharmacy, while the prevention program averaged six months.^[2] Detection and prevention run on different clocks, so ownership must extend well past the screening event.

Measurement can break the continuum as well. In the Peruvian occupational cohort, only 12,049 of 79,660 workers (15.1%) had longitudinal dental follow-up.^[13] The authors noted that limited follow-up reduces generalizability and may reflect uneven surveillance.^[13] When follow-up data are this sparse, a system cannot tell whether people were lost or simply never measured. Closed-loop reporting should count everyone who should have been followed, not only those who were.

Enrollment is also not the finish line. In a feasibility program for kidney transplant candidates with obesity, participants attended 15 weekly virtual group sessions using the National Diabetes Prevention Program curriculum.^[7] Participants attending at least half of the sessions had greater median weight loss than those with lower attendance, independent of GLP-1 use.^[7] The authors concluded that session engagement, rather than medication alone, appeared to drive outcomes.^[7]

Figure 3

Why the pathway breaks

People

Pharmacists screen without a named receiving clinician
Coaches and educators lack protected time for follow-up
Clinical staff not involved in recruitment and content design

Process

Abnormal results routed back to primary care with no tracking
No direct referral from screening to a prevention program
Screening and prevention run on different timelines with no shared owner

Technology

Partner-site results do not reach the accountable clinician’s record
Risk models lack subgroup validation
Digital programs raise unresolved privacy questions

Environment

Rural distance between pharmacy and general practice
Partner pharmacies drop out of pilots
Deprived neighborhoods underrepresented in clinic-based screening

Policy

Screening criteria miss many young adults with prediabetes
Navigation billing rules create administrative friction
Adult criteria applied to children and adolescents

Measurement

Follow-up counted only for people who returned
Enrollment tracked but session attendance not reported
Results not stratified by age and deprivation

Unranked qualitative cause-and-effect diagram for the outcome in the box: People identified as at risk for diabetes do not reach a confirmed result and an attended prevention program Causes are assembled from the cited literature [1], [2], [3], [4], [6], [7], [8], [9], [10], [13]; categories are not weighted and their order carries no meaning.

Data note. Qualitative; no frequencies are implied.

Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.

Figure data (6 rows)

Figure 3 data: Why the pathway breaks
Category	Causes drawn from the cited literature
People	Pharmacists screen without a named receiving clinician; Coaches and educators lack protected time for follow-up; Clinical staff not involved in recruitment and content design
Process	Abnormal results routed back to primary care with no tracking; No direct referral from screening to a prevention program; Screening and prevention run on different timelines with no shared owner
Technology	Partner-site results do not reach the accountable clinician’s record; Risk models lack subgroup validation; Digital programs raise unresolved privacy questions
Environment	Rural distance between pharmacy and general practice; Partner pharmacies drop out of pilots; Deprived neighborhoods underrepresented in clinic-based screening
Policy	Screening criteria miss many young adults with prediabetes; Navigation billing rules create administrative friction; Adult criteria applied to children and adolescents
Measurement	Follow-up counted only for people who returned; Enrollment tracked but session attendance not reported; Results not stratified by age and deprivation

Access

Bringing risk testing to places people already use

Pharmacies extend the front door. In the UAE study, a survey of 279 community members found 84% acceptance of pharmacy-based screening, and 59% considered pharmacies suitable locations.^[2] The authors described pharmacy screening as an entry point to prevention and a replicable framework for cardiometabolic services.^[2] For a health system, that framing turns a retail partner into part of the referral network. It also raises practical questions about data sharing, result ownership and how partner staff reach a clinician when a value is high.

Feasibility is real but uneven. Of 17 pharmacies enrolled in the rural New South Wales pilot, 9 completed the study, recruiting 116 adults over five months.^[3] The authors judged pharmacy-led screening operationally feasible in rural Australia and found substantial undiagnosed diabetes.^[3] Losing nearly half of the participating sites is an operating risk in its own right. Contracts, training and practical support for partner pharmacies deserve the same attention as the testing itself.

Test selection is an access decision as well as a clinical one. Because fasting glucose performed worst among three criteria in high-risk relatives, the study authors favored HbA1c for large-scale screening.^[5] Point-of-care HbA1c was a screening test in all three pharmacy studies reviewed here.^[1]^[2]^[3] Leaders should confirm that results from partner sites flow into the record that the accountable clinician actually reviews. A point-of-care result that lives only on a paper slip or a partner system is easy to lose at the very moment it matters.

Other clinical settings offer additional doors. A Nigerian before-and-after study of 77 periodontitis patients, 45 with diabetes and 32 with prediabetes, suggested that a mouthrinse point-of-care test could support diabetes risk screening in dental and medical care.^[14] A cross-sectional study of 97 patients with prediabetes and 44 controls linked static balance measures with prediabetes, although the model still needs external validation.^[15] These tools are early, but they show that risk detection can sit inside services people already visit. Each new door, however, needs the same receiving clinician and result route as the pharmacy model.

Digital prevention can extend reach after detection. A narrative review found that automated and semi-automated digital programs show potential to support lifestyle change, improve engagement and reduce reliance on labor-intensive counseling.^[9] It also cautioned that limited external validation, privacy concerns and uncertain long-term effectiveness still constrain routine use.^[9]

System route

Connect awareness to confirmed action.

The route should distinguish risk assessment, screening, diagnosis, diabetes type, and individualized care.

The route at a glance

Recognize risk
Test appropriately
Connect prevention
Start and sustain care

Recognize risk
Use validated tools and current clinical criteria without blaming people for weight, behavior, or family history.
Test appropriately
Order and complete indicated laboratory testing, then confirm and classify results under current standards.
Connect prevention
Offer eligible people access to evidence-based diabetes prevention and address practical barriers.
Start and sustain care
Coordinate education, medicines, technology, nutrition, eye, kidney, foot, cardiovascular, and psychosocial care.

Reliability rule: Do not imply that type 1 diabetes is preventable through lifestyle change or that every person with prediabetes will develop type 2 diabetes.

Figure 2

The system route as one flow

The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.

Data note. Shows sequence and handoffs only; it carries no counts or rates.

Limitation. Local processes may add, merge or reorder stages under organizational policy.

Figure data (4 rows)

Figure 2 data: The system route as one flow
Stage	What the stage requires
Recognize risk	Use validated tools and current clinical criteria without blaming people for weight, behavior, or family history.
Test appropriately	Order and complete indicated laboratory testing, then confirm and classify results under current standards.
Connect prevention	Offer eligible people access to evidence-based diabetes prevention and address practical barriers.
Start and sustain care	Coordinate education, medicines, technology, nutrition, eye, kidney, foot, cardiovascular, and psychosocial care.

Equity and trust

Who current detection pathways leave out

Criteria-based screening leaves predictable gaps. The finding that 32.7% of U.S. young adults with prediabetes would not qualify for screening points to a younger group that standard eligibility rules underserve.^[4] Systems that test only when criteria trigger an alert should examine who falls outside those criteria in their own population. Age, insurance, language and neighborhood are reasonable starting points for that review. The aim is not to test everyone, but to know which groups the current rules consistently pass over.

Venue changes who is reached. In the Scottish study, pharmacies recruited relatively younger participants from more deprived backgrounds than the general practice comparison group.^[1] Among pharmacy participants, 63% lived in the two most deprived area categories, compared with 33% in the general practice cohort.^[1] The authors concluded that pharmacies provided effective, equitable access to testing and prevention for people being missed by current pathways.^[1] For systems serving deprived neighborhoods, a partner venue may reach people that clinic invitations do not. That reach only becomes equity when results and referrals return to an accountable team.

Cultural fit is part of access. Before launch, the UAE team ran stakeholder surveys and interviews, held focus groups, translated and culturally adapted the Diabetes Prevention Program and trained participating pharmacists.^[2] That preparation phase is easy to compress under deadline pressure. Yet it was the step designed to make the prevention offer usable by the community it served.^[2] Health systems adopting a prevention curriculum should budget time for adaptation and partner training, rather than treating translation as a final formatting task.

New tools carry their own equity risks. The review of artificial intelligence in prediabetes care flagged limited external validation across diverse populations and a geographic imbalance in the evidence.^[9] It called for multi-center, prospective and implementation-focused studies to establish equity, safety and cost-effectiveness before wider adoption.^[9] Leaders evaluating vendor risk models should ask for subgroup performance in populations like their own. A model that performs well on average can still miss the groups an equity plan is meant to protect.

Age-specific rules are an equity issue too. The pediatric review warns that adult-based diagnostic criteria do not transfer cleanly to youth.^[10] Stratified dashboards should therefore separate children, young adults and older adults, so that a strong overall rate does not hide a group the pathway was never designed to reach.

A nurse practitioner explains test results to the man from the pharmacy and his wife in an exam room. — Illustrative image. In one Scottish program, pharmacies reached participants from more deprived backgrounds than general practice screening did.^[1]

Human infrastructure

The people who carry the risk-to-prevention handoff

Pharmacists, educators and coaches did the core work in these studies. In the UAE program, trained pharmacists delivered evidence-based screening protocols, and diabetes educators delivered the prevention sessions.^[2] In the kidney transplant program, trained lifestyle coaches led the group sessions, with interprofessional pharmacotherapy management and remote monitoring alongside.^[7] In that program, GLP-1 therapy use rose from 62.1% at baseline to 72.4% at session 15, and 52.4% reached high-dose therapy.^[7]

Clinician involvement shapes adoption. In an evaluation of TeenLyft, a six-month behavioral program adapted from the Diabetes Prevention Program for adolescents having bariatric surgery, adoption was influenced by clinical staff involvement.^[8] Staff helped with recruitment, content development and aligning content with adolescent needs.^[8] Of 76 adolescents who enrolled, 29 completed surgery, and participants said the program supported their physical and emotional health.^[8] They also wanted more mental health content, which points to the staffing mix a program may need.^[8] Programs adapted from the same prevention curriculum may need different team compositions for different populations.

Navigation needs administrative scaffolding. A commentary on Medicare principal illness navigation argues that coverage has not translated reliably into access because the main barriers are administrative and operational.^[6] The billing practitioner must perform an initiating visit and remains responsible for supervision, documentation and billing, even when navigators work outside the practice.^[6] The authors cite the Medicare Diabetes Prevention Program as an example where CMS modified delivery rules once operational barriers emerged.^[6]

Technology can support the workforce, but it does not replace it. The artificial intelligence review describes these tools as assistive technology that may support earlier detection, more precise risk stratification and scalable lifestyle management.^[9] It also identifies the need for stronger governance frameworks.^[9] In practice, that means someone must own model monitoring, staff must know when to override a score and patients must know a person is accountable for their result.

For executives, the lesson is that every role in the chain needs a defined scope, a referral destination and a way to see whether the person arrived. Pharmacist screening without a receiving clinician, or coaching without protected time, recreates the same leak in a new place. Workforce plans should therefore be built around the handoff, with each role’s caseload sized to the referral volume the screening effort will generate.

Operating dashboard

Measure testing, diagnosis, connection, and equity.

Separate type 1, type 2, gestational diabetes, and prediabetes where clinically and analytically appropriate.

Four operating signals

Testing completionDiagnostic closureProgram connectionAccess equity

Each signal pairs an executive question with one candidate local measure, set out below.

Testing completion

Track risk-based testing from order to completed result.

Measure: Eligible people completing laboratory testing

Diagnostic closure

Follow abnormal results to confirmation, classification, and documented communication.

Measure: Abnormal results with completed disposition

Program connection

Measure completed entry into selected prevention or diabetes-care services.

Measure: People completing first program or care visit

Access equity

Review completion and delay across priority populations.

Measure: Gap in completion and time by group

Figure 4

The operating system behind the dashboard

The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.

Data note. Structural diagram; no measured values.

Limitation. Owners are candidates to be confirmed locally.

Figure data (4 rows)

Figure 4 data: The operating system behind the dashboard
Operating signal	Candidate owner
Testing completion	Primary care and population health
Diagnostic closure	Clinical quality
Program connection	Care management
Access equity	Access and equity leaders

Handoff workflow

Carry the result, urgency, and next responsibility forward.

People should not receive an abnormal value without a clear explanation and a reachable care plan.

How responsibility moves

Lane 1Risk tool to clinician3 steps

Lane 2Laboratory to diagnosis3 steps

Lane 3Diagnosis to longitudinal support3 steps

Lane

Risk tool to clinician

Explain that the result is not a diagnosis.
Arrange appropriate testing.
Give urgent symptom guidance.

Lane

Laboratory to diagnosis

Notify the accountable clinician.
Communicate the result and uncertainty.
Confirm the follow-up appointment.

Lane

Diagnosis to longitudinal support

Clarify type and treatment plan.
Connect education, supplies, and coverage help.
Assign monitoring and escalation responsibilities.

A referral to a prevention program is not appropriate for every diabetes type or every abnormal result. Use confirmed eligibility and patient choice.

Executive scorecard

Ask whether awareness reaches diagnosis and support.

Avoid celebrating risk-test volume when testing and care remain inaccessible.

Who reviews what

Primary care and population health
Clinical quality
Care management
Access and equity leaders

Candidate owners named in the scorecard, confirmed locally.

Use stable definitions and stratify results by site, population, and service line when appropriate.
Signal	Executive question	Accountable owner	Review cadence
Recognition	Are high-risk people offered an appropriate next step?	Primary care and population health	Monthly
Closure	How many abnormal results remain unresolved?	Clinical quality	Weekly
Connection	Do eligible people complete prevention or diabetes-care entry?	Care management	Monthly
Equity	Which groups face the longest delay or highest abandonment?	Access and equity leaders	Quarterly

Figure 5

Control points for a closed-loop diabetes risk pathway

Figure 5: Control points for a closed-loop diabetes risk pathway
Control point	Risk if missing	Owner	Evidence of control
Agreed screening test and eligibility rules, including people outside standard criteria	High-risk young adults and relatives are never tested	Primary care medical director with population health lead	Share of the at-risk population with a documented HbA1c in the review period
Named receiving clinician for every partner-site abnormal result	Abnormal results go unconfirmed after pharmacy referral	Ambulatory quality lead and pharmacy partnership manager	Share of abnormal partner results with confirmatory testing completed
Direct referral route from confirmed prediabetes to a prevention program	People must complete several handoffs alone and drop out	Population health director and prevention program manager	Share of confirmed prediabetes referred and enrolled
Attendance tracking after enrollment	Enrollment counts hide low engagement	Prevention program manager	Share of enrollees attending at least half of sessions
Partner site support and retention	Pharmacies leave the program and access shrinks	Community partnership lead	Active partner sites at each quarterly review
Stratified reporting by age, deprivation and language	Overall rates hide groups the pathway does not reach	Health equity officer	Completion gaps by group reviewed quarterly
Validation and privacy review for digital and risk-model tools	Tools underperform or erode trust in some populations	Chief medical information officer	Documented subgroup performance and privacy assessment before go-live

Control points derived from the cited evidence [1], [2], [3], [4], [5], [7], [9] and this brief’s executive guidance.

Data note. Each row is a control to verify, not a measured result.

Limitation. Owners and evidence of control must follow local policy and applicable requirements.

Public communication

Communicating risk so that people take the next step

Trust problems are often administrative before they are clinical. The navigation commentary describes a broader trust problem in the administrative pathway that makes clinicians cautious, even when a service is covered.^[6] It recommends plain-language guidance, clearer risk boundaries and simpler enrollment and payment pathways.^[6] It also calls for measuring activation, onboarding time and successful service delivery.^[6] Referral partners in diabetes prevention need the same clarity before they will promote a program with confidence.

Channels should match the audience. TeenLyft delivered online educational videos and added social media platforms during implementation to boost engagement.^[8] Adolescents emphasized that the program gave them education and skills to support weight management after surgery.^[8] In the UAE program, educators delivered personalized sessions designed to be culturally appropriate for participants.^[2] Neither program relied on a single generic leaflet. Both shaped the format and the channel around the people they needed to reach.

Messages should not depend on an invitation that some people will never receive. Because one in three young adults with prediabetes would fall outside current screening criteria, public campaigns that tell people to wait for a clinician’s prompt may miss them.^[4] Messages for families of children need a different tone. The pediatric review notes that lifestyle modification remains the primary intervention because drug treatments have yet to show efficacy in youth.^[10]

Specialty services can repeat the same message. The sleep apnea meta-analysis authors supported considering sleep apnea screening in people with prediabetes, which gives sleep and primary care teams a shared conversation.^[12] Dental teams have a similar opening. Screening-detected prediabetes was associated with incident caries in working adults, and a mouthrinse point-of-care test has been proposed to support risk screening in dental care.^[13]^[14] Consistent language across these services makes a single risk finding easier to act on. When a dentist, a sleep clinician and a primary care team describe the same result in the same way, people receive one clear message instead of three partial ones.

Finally, communication should be judged by response, not reach. A result message counts as complete when the person understands what it means, knows the next step and has a way to take it. That standard turns Diabetes Alert Day from a campaign into a measurable service. It also gives communication teams a shared outcome with clinical teams, instead of a separate count of impressions or materials distributed.

The man and his wife walk together on a park path lined with spring blossoms. — Illustrative image. In one program using a diabetes prevention curriculum, participants who attended more sessions lost more weight.^[7]

90-day plan

Close one diabetes detection gap in 90 days.

Choose a population with low testing completion or high unresolved abnormal results.

Ninety days, three moves

Days 1–30Trace the alert
Days 31–60Test closed-loop action
Days 61–90Make early action routine

Days 1–30

Trace the alert

Map risk through diagnosis and connection.
Review 30 recent cases.
Baseline completion and disparities.

Days 31–60

Test closed-loop action

Pair risk assessment with lab access.
Create an abnormal-result worklist.
Warm-transfer eligible services.

Days 61–90

Make early action routine

Compare completion and delay.
Embed ownership and escalation.
Set the next prevention or care target.

Figure 6

The 90-day plan on one timeline

The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.

Data note. Time boxes are a management framework, not a clinical timeline.

Limitation. Durations are uniform 30-day windows; real tasks may span windows.

Figure data (9 rows)

Figure 6 data: The 90-day plan on one timeline
Window	Action
Days 1–30	Map risk through diagnosis and connection.
Days 1–30	Review 30 recent cases.
Days 1–30	Baseline completion and disparities.
Days 31–60	Pair risk assessment with lab access.
Days 31–60	Create an abnormal-result worklist.
Days 31–60	Warm-transfer eligible services.
Days 61–90	Compare completion and delay.
Days 61–90	Embed ownership and escalation.
Days 61–90	Set the next prevention or care target.

An alert matters only when action is possible.

Diabetes Alert Day 2026 should help people move from risk awareness to accurate diagnosis and appropriate support without stigma.

Executive action
Sponsor one closed-loop risk-to-diagnosis pilot and review testing, diagnostic closure, and service connection within 90 days.

Operational readiness verification

Make the observance visible in everyday operations.

Diabetes Alert Day becomes meaningful when people move from risk identification to appropriate testing, result communication, prevention or treatment, and follow-up. The weak version is a message without an operating change. The stronger version defines what teams should see, who owns each transition, how exceptions escalate, and how leaders know that the pathway actually closed.

The principal failure mode is that risk screening can become a one-day event without diagnostic confirmation, understandable results, prevention support, or ongoing care. Leaders should test the route with recent cases, frontline staff, patients or community partners, and the teams that receive the next handoff. That review should distinguish a written policy from reliable execution under real workload, staffing, access, and communication conditions.