Screening for diabetes in black barbershops

Community-Based Hemoglobin A1C Testing in Barbershops to Identify Black Men With Undiagnosed Diabetes

Literature - Osorio M, Ravenell JE, Sevick MA et al., - JAMA Intern Med. 2020. doi:10.1001/jamainternmed.2019.6867.

Introduction and methods

Black men with diabetes have higher rates of diabetic complications compared with diabetic men in other racial and ethnic groups [1,2]. Black men with diabetes who do not have a regular source of primary care are often diagnosed late. Community-based interventions in barbershops have been successful for the identification and treatment of hypertension in men [3]. This study evaluated a community-based approach for diabetes screening in barbershops using hemoglobin A1C (HbA1C) testing.

The study was conducted in 8 barbershops owned by black individuals in neighborhoods previously identified as having a high prevalence of poor glycemic control in Brooklyn, New York [4]. English-speaking black men aged ≥18 years without a history of diabetes were asked to participate. Point-of-care HbA1C tests were used that provided test results within 5 min and that had a reported accuracy of 93% compared with HbA1C testing of venous blood [5].

Patients with a HbA1C level of ≥6.5%, based on a single test result, were considered to have diabetes. Tests to confirm this result were not performed. Men with a HbA1C level ≥5.7% were informed about the importance of diet modification, physical activity and need for medical management. Contact information of a local primary care clinic was also provided.

Main results

  • 895 Men were asked to take part in the study, 312 (34.9%) agreed to participate and 290 (32.4%) were successfully tested.
  • Of the 290 successfully tested men, 26 (9.0%) men had a HbA1C level ≥6.5% and were considered to have diabetes. Of these 26 men with undiagnosed diabetes, 16 (61.5%) were obese and 11 (42.3%) had an education of high school or less. The median age of these 26 men was 41 years (range 22-65).
  • 82 Men (28.3%) had a HbA1C level between 5.7% and 6.4%, which is the criterion for diagnosing prediabetes.


This study evaluating a community-based screening approach in 8 barbershops in Brooklyn, New York found a prevalence of undiagnosed diabetes in 9.0% of the black male participants. While the study sample might not be representative of other barbershops, the results suggests that community-based diabetes screening in barbershops may contribute to the identification and timely diagnosis of diabetes in black men.

While exact numbers are missing, this study found that barbers can motivate customers to participate in testing for diabetes. Some customers who initially declined testing for diabetes, agreed after encouragement from the barber.


1. Lee DC, Young T, Koziatek CA, et al. Age disparities among patients with type 2 diabetes and associated rates of hospital use and diabetic complications. Prev Chronic Dis. 2019;16:E101. doi:10.5888/pcd16.180681

2. Lee DC, Long JA, Sevick MA, et al. The local geographic distribution of diabetic complications in New York City: associated population characteristics and differences by type of complication. Diabetes Res Clin Pract. 2016;119:88-96. doi:10.1016/j.diabres.2016.07.008

3. Victor RG, Ravenell JE, Freeman A, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med. 2011;171(4):342-350. doi:10.1001/archinternmed.2010.390

4. Lee DC, Jiang Q, Tabaei BP, et al. Using indirect measures to identify geographic hot spots of poor glycemic control: cross-sectional comparisons with an A1C registry. Diabetes Care. 2018;41(7):1438-1447. doi:10.2337/dc18-0181

5. Chang A, Frank J, Knaebel J, Fullam J, Pardo S, Simmons DA. Evaluation of an over-the-counter glycated hemoglobin (A1C) test kit. J Diabetes Sci Technol. 2010;4(6):1495-1503. doi:10.1177/193229681000400625

Find this article online at JAMA Intern Med

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