More than 101 million Americans live in federally designated primary care shortage areas, according to federal data from March 2026. Without a regular doctor, many go to urgent care instead. Nearly 30% of US adults visited an urgent care center or retail clinic in 2019, the CDC found.

Those visits are a screening opportunity that largely goes unused. A fingerstick A1c needs no fasting and no specialized operator, and it returns a result in about 10 minutes. It is not routinely built into urgent care workflows. Meanwhile, 11 million US adults have diabetes and don’t know it, and 8 in 10 of the 115 million with prediabetes are also unaware, according to the CDC. Most never get tested at the place they actually show up for care.

The Evidence Ends at What Is Possible

The feasibility question was settled years ago. When emergency physicians compared fingerstick A1c against lab values in 2008, the two tracked closely, and the correlation reached 0.96 among patients with no prior diabetes diagnosis. Of those patients, 29% had an abnormal result. A 2021 analysis of records from a health network across upstate South Carolina, spanning seven emergency departments and six urgent care centers, found unrecognized diabetes in 4.58% of patients and prediabetes risk in about a third more. By 2025, a review in Clinical Diabetes argued for wider access to Clinical Laboratory Improvement Amendments-waived point-of-care testing, which can be run by nonlaboratory staff.

Possibility is all these studies establish. A positive fingerstick still has to be confirmed, since the American Diabetes Association does not accept a single reading as diagnostic. And whether catching the disease in an urgent care chair changes its course years later is a question none of them was built to answer.

Inside the healthcare system, Jamal Ross, MD, chief medical officer at Friend Health, which provides care to underserved parts of Chicago, has seen how gaps in access play out firsthand. Early detection of conditions like diabetes or prediabetes often slips through when services stay fragmented. Immediate care, Ross said, “can be an important access point for identifying diabetes, prediabetes, and other chronic disease risks earlier.” Yet most diagnoses today depend on yearly checkups and ongoing ties to a regular provider. For people in underserved areas, such continuity simply does not exist.

Practice remains unshifted despite the data.

After the Fingerstick

What stopped progress wasn’t the test itself. Urgent care is built around moving from one acute problem to the next, leaving little room for follow-up when an unusual result appears, and most centers lack a clear workflow for that. Since 2024, Medicare allows up to two diabetes screening tests per year for at-risk beneficiaries, and A1c is one of the covered screening options. Urgent care uptake has lagged.

“The screening result matters, but the follow-up system determines whether it actually improves the patient’s health,” Ross said. Administrators point out one hurdle, Ross said: adding discussions and checks into appointments meant to move fast creates strain, and expanding such efforts stretches teams beyond how roles were originally planned.

Back in 2008, during a hospital emergency study, just 38% of people who had unusual results returned for further checks. Researchers at the time pointed out that without better follow-through, routine screening made little sense. Despite nearly 20 years passing, the follow-up gap remains substantial.

Patients who come to urgent care may not have a regular clinician to follow-up with. Programs that work often sit idle. Sarah Goodpastor, MD, an internal medicine physician and clinical diabetologist at Mercy Diabetes and Nutrition Center in Durango, Colorado, pointed to lifestyle-intervention programs like the National Diabetes Prevention Program, which she said have been “shown to reduce the progression to type 2 by 58% but are not routinely prescribed due to lack of awareness.”

The same hesitation carries into therapy: When blood sugar goals aren’t met, treatment stays unchanged for close to half of patients, Goodpastor said.

Not everyone gets tested at all.

“Because there is such an emphasis on the idea that type 2 diabetes is a lifestyle problem, people with relatively good lifestyle often get missed despite having other significant risks,” said Gillian Goddard, MD, an endocrinologist in New York City.

Money worsens what already fails. When care settings shift or insurance vanishes, access breaks down, and high prices block even insured patients from the best treatments. “In my experience, this is the biggest limiting factor,” Goddard said.

Damage That Does Not Go Away

Most of the time, pancreatic beta-cell function is already down 40%-50% or more by the point blood sugar looks off, Goodpastor said — the insulin response after eating slips first. By the time results hint at prediabetes, the damage is well underway.

“By the time I see a patient who already has type 2 diabetes, silent damage has already started,” said Manikya Kuriti, MD, an endocrinologist in Louisville, Kentucky.

What shows up during exams isn’t always reversible — microalbuminuria points to early kidney strain, and nerve issues in the limbs mean treatment focuses on managing discomfort rather than repair.

Many people only learn they have diabetes after ending up in the hospital. The insulin-producing cells “an experience a type of shock and stop producing insulin,” Goodpastor said, a state she called glucose toxicity. Often the diagnosis comes during treatment for diabetic ketoacidosis. Sometimes it surfaces after a heart attack, since heart disease is the leading cause of death in people with diabetes.

“I have one patient who was already in kidney failure by the time he was diagnosed,” Goddard said.

A single instance stands out to Ross — this one moved opposite the usual path. Someone arrived focused on an entirely different issue, showing none of the typical warning signs, yet flagged during routine risk assessment. Blood results revealed an A1c level sitting at 11.0%. Further exams detected early kidney problems, so care began immediately.

The case, Ross said, shows screening is “about finding disease earlier, identifying complications sooner.”

Ready for What Comes After

Screening for diabetes was never the original aim of urgent care. Pushed by limited options, patients arrived there anyway. What happens after detection — managing long-term needs triggered by unusual results — remains unanswered across healthcare networks.

Kuriti keeps seeing the same thing.

“When I review patients who come to me for type 2 diabetes, it is common that they have had A1c levels in the prediabetic range,” she said. “This is a totally preventable progression.”

No reported disclosures.