Population-scale prediabetic assessment using HbA1c from menstrual blood

CDC-recommended diabetes prevention programs aim to detect and reverse disease in the one-third of Americans with prediabetes, but high-compliance serial assessment of percent hemoglobin A1c (HbA1c) remains a barrier to delivering this vision at population scale. Venous phlebotomy is challenging for busy or resource-constrained patients. In this paper, we introduce the first-ever quantitative diagnostic test based on menstrual fluid, which allows HbA1c quantification from self-collected mailed tampons.We demonstrate that menstrual HbA1c is comparable to venous HbA1c in the diagnosis of prediabetes with the standard threshold of 5.7. We also demonstrate accuracy, precision, stability, and interference testing. Finally, surveying subjects reveals strong preference for menstrual HbA1c in quarterly testing. These findings suggest that menstrual HbA1c can be a key tool in addressing prediabetes at population scale.