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Royce N, Cronjé HT, Kengne AP, Kruger HS, Dolman-Macleod RC, Pieters M. HbA1c comparable to fasting glucose in the external validation of the African Diabetes Risk Score and other established risk prediction models in Black South Africans. BMC Endocr Disord 2024; 24:213. [PMID: 39390433 PMCID: PMC11465613 DOI: 10.1186/s12902-024-01735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The use of non-invasive risk scores to detect undiagnosed type 2 diabetes (T2D) ensures the restriction of invasive and costly blood tests to those most likely to be diagnosed with the disease. This study assessed and compared the performance of the African Diabetes Risk Score (ADRS) with three other diabetes risk prediction models for identifying screen-detected diabetes based on fasting plasma glucose (FPG) or glycated haemoglobin (HBA1c). METHODS Age, sex, waist circumference, body mass index, blood pressure, history of diabetes and physical activity levels from the SA-NW-PURE study were used to externally validate the ADRS and other established risk prediction models. Discrimination was assessed and compared using C-statistics and nonparametric methods. Calibration was assessed using calibration plots, before and after recalibration. RESULTS Nine hundred and thirty-seven participants were included; 14% had prevalent undiagnosed T2D according to FPG and 26% according to HbA1c. Discrimination was acceptable and was mostly similar between models for both diagnostic measures. The C-statistics for diagnosis by FPG ranged from 0.69 for the Simplified FINDRISC model to 0.77 for the ADRS model and 0.77 for the Simplified FINDRISC model to 0.79 for the ADRS model for diagnosis by HbA1c. Calibration ranged from acceptable to good, though over- and underestimation were present. All models improved significantly following recalibration. CONCLUSIONS The models performed comparably, with the ADRS offering a non-invasive way to identify up to 79% of cases. Based on its ease of use and performance, the ADRS is recommended for screening for T2D in certain Black population groups in South Africa. HbA1c as a means of diagnosis also showed comparable performance with FPG. Therefore, further validation studies can potentially use HbA1c as the standard to compare to.
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Affiliation(s)
- Nicola Royce
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom Campus Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Héléne T Cronjé
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - André P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom Campus Private Bag X6001, Potchefstroom, 2520, South Africa
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Robin C Dolman-Macleod
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom Campus Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Marlien Pieters
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom Campus Private Bag X6001, Potchefstroom, 2520, South Africa.
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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Oba S, Murakami H, Saitoh T, Hayashi K, Okada Y, Imano Y, Takaki O, Kiryu I, Ishikawa M, Sato Y. Factors Related to Diagnosis of Diabetes After Detecting High Blood Glucose Levels Through Screening: One-Year Follow-up Among Publicly Insured Adults in Gunma, Japan. Asia Pac J Public Health 2024; 36:595-602. [PMID: 39054586 DOI: 10.1177/10105395241262852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
This study aimed to assess the diagnosis of diabetes after detecting high blood glucose levels through screening among insured individuals in Gunma, Japan. Data for men and women 35 to 74 years of age were provided by Japan Health Insurance Association, and 4133 individuals with high blood glucose levels while not currently being treated for diabetes were included in the study. About 13% received a diagnosis of diabetes at a subsequent physician visit, and individuals who were under treatment for hypertension were less likely to receive the added diagnosis of diabetes compared with those not being treated for hypertension (odds ratio = 0.42 from a logistic regression model). Fasting blood glucose levels were significantly improved in the next year only among individuals with a confirmed diagnosis of diabetes.
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Affiliation(s)
- Shino Oba
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Center for Food Science and Wellness, Gunma University, Maebashi, Japan
- Interfaculty Initiative in Public Health, Gunma University, Maebashi, Japan
| | - Hirokazu Murakami
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Gunma University of Health and Welfare, Maebashi, Japan
| | - Takayuki Saitoh
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Yoshihisa Okada
- Japan Health Insurance Association, Gunma Branch, Maebashi, Japan
| | - Yasuko Imano
- Japan Health Insurance Association, Gunma Branch, Maebashi, Japan
| | - Osamu Takaki
- Faculty of Informatics, Gunma University, Maebashi, Japan
| | - Ikue Kiryu
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- School of Nursing, Dokkyo Medical University, Shimotsuga, Japan
| | - Mai Ishikawa
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Yumi Sato
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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El-Khoury R, Chemaitelly H, Alaama AS, Hermez JG, Nagelkerke N, Abu-Raddad LJ. Hepatitis C risk score as a tool to identify individuals with HCV infection: a demonstration and cross-sectional epidemiological study in Egypt. BMJ Open 2024; 14:e085506. [PMID: 38950989 PMCID: PMC11340217 DOI: 10.1136/bmjopen-2024-085506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES Hepatitis C virus (HCV) infection poses a global health challenge. By the end of 2021, the WHO estimated that less than a quarter of global HCV infections had been diagnosed. There is a need for a public health tool that can facilitate the identification of people with HCV infection and link them to testing and treatment, and that can be customised for each country. METHODS We derived and validated a risk score to identify people with HCV in Egypt and demonstrated its utility. Using data from the 2008 and 2014 Egypt Demographic and Health Surveys, two risk scores were constructed through multivariable logistic regression analysis. A range of diagnostic metrics was then calculated to evaluate the performance of these scores. RESULTS The 2008 and 2014 risk scores exhibited similar dependencies on sex, age and type of place of residence. Both risk scores demonstrated high and similar areas under the curve of 0.77 (95% CI: 0.76 to 0.78) and 0.78 (95% CI: 0.77 to 0.80), respectively. For the 2008 risk score, sensitivity was 73.7% (95% CI: 71.5% to 75.9%), specificity was 68.5% (95% CI: 67.5% to 69.4%), positive predictive value (PPV) was 27.8% (95% CI: 26.4% to 29.2%) and negative predictive value (NPV) was 94.1% (95% CI: 93.5% to 94.6%). For the 2014 risk score, sensitivity was 64.0% (95% CI: 61.5% to 66.6%), specificity was 78.2% (95% CI: 77.5% to 78.9%), PPV was 22.2% (95% CI: 20.9% to 23.5%) and NPV was 95.7% (95% CI: 95.4% to 96.1%). Each score was validated by applying it to a different survey database than the one used to derive it. CONCLUSIONS Implementation of HCV risk scores is an effective strategy to identify carriers of HCV infection and to link them to testing and treatment at low cost to national programmes.
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Affiliation(s)
- Rayane El-Khoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Ahmed S Alaama
- Department of Communicable Diseases, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nico Nagelkerke
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Rokhman MR, Arifin B, Broggi B, Verhaar AF, Zulkarnain Z, Satibi S, Perwitasari DA, Boersma C, Cao Q, Postma MJ, van der Schans J. Impaired health-related quality of life due to elevated risk of developing diabetes: A cross-sectional study in Indonesia. PLoS One 2023; 18:e0295934. [PMID: 38117810 PMCID: PMC10732360 DOI: 10.1371/journal.pone.0295934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND This study investigated the association between elevated risk of developing diabetes and impaired health-related quality of life (HRQoL) in the Indonesian population. METHODS A cross-sectional study was conducted on 1,336 Indonesians from the general population who had no previous diagnosis of diabetes. Utility score to represent HRQoL was measured using the EuroQol 5-dimension, while the risk for developing diabetes was determined using the Finnish Diabetes Risk Score (FINDRISC) instrument. All participants underwent a blood glucose test after fasting for 8 hours. The association between FINDRISC score and HRQoL adjusted for covariates was analysed using multivariate Tobit regression models. Minimal clinically important differences were used to facilitate interpretation of minimal changes in utility score that could be observed. RESULTS The median (interquartile range) of the overall FINDRISC score was 6 (7), while the mean (95% confidence intervals) of the EQ-5D utility score was 0.93 (0.93-0.94). Once adjusted for clinical parameters and socio-demographic characteristics, participants with a higher FINDRISC score showed a significantly lower HRQoL. No significant association was detected between fasting blood glucose level categories and HRQoL. A difference of 4-5 points in the FINDRISC score was considered to reflect meaningful change in HRQoL in clinical practice. CONCLUSION An elevated risk of developing diabetes is associated with a lower HRQoL. Therefore, attention should be paid not only to patients who have already been diagnosed with diabetes, but also to members of the general population who demonstrate an elevated risk of developing diabetes. This approach will assist in preventing the onset of diabetes and any further deterioration of HRQoL in this segment of the Indonesian population.
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Affiliation(s)
- M. Rifqi Rokhman
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & HealthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bustanul Arifin
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
- Disease Prevention and Control Division, Banggai Laut Regency Health, Population Control and Family Planning Service, Central Sulawesi, Indonesia
- Unit of Pharmaco Therapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Benedetta Broggi
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne-Fleur Verhaar
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Zulkarnain Zulkarnain
- Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Thyroid Center, Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Satibi Satibi
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Cornelis Boersma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Management Sciences, Open University, Heerlen, The Netherlands
| | - Qi Cao
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & HealthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Unit of Pharmaco Therapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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Abu-Dayyeh I, Chemaitelly H, Ghunaim M, Hasan T, Abdelnour A, Abu-Raddad LJ. Patterns and trends of hepatitis C virus infection in Jordan: an observational study. Front Public Health 2023; 11:1280427. [PMID: 38146470 PMCID: PMC10749371 DOI: 10.3389/fpubh.2023.1280427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/16/2023] [Indexed: 12/27/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection levels in Jordan remain uncertain. No HCV national population-based survey has ever been conducted in the country. To meet the World Health Organization's target of reducing HCV incidence to ≤5 per 100,000 people per year by 2030, it is essential to determine the infection levels, identify affected individuals and populations, and provide appropriate treatment using direct-acting antivirals to individuals carrying the virus. Methods The study utilized the HCV testing database of 28,798 attendees of Biolab Diagnostic Laboratories in Jordan, covering the period from January 19, 2010, to May 26, 2023. Cross-sectional and cohort study analyses were conducted, including estimating HCV antibody (Ab) prevalence, examining associations with HCV Ab positivity, determining the HCV viremic rate, and estimating HCV incidence rate using a retrospective cohort study design. Results A total of 27,591 individuals, with a median age of 31.3 and 52.9% being females, underwent HCV Ab testing, while 1,450 individuals, with a median age of 42.2 and 32.8% being females, underwent HCV RNA PCR testing. The study sample HCV Ab prevalence was 4.0% (95% CI: 3.7-4.2%). After applying probability weights, the weighted HCV Ab prevalence was 5.8% (95% CI: 4.6-7.3%). Age was strongly associated with HCV Ab positivity, particularly among individuals aged 50 years or older, who had 10-fold higher odds of being HCV Ab positive compared to those aged 10-19 years. Males had 2.41-fold higher odds of testing positive for HCV Ab compared to females. The HCV viremic rate was 54.1% (95% CI: 43.0-65.0%). The cumulative incidence of HCV infection, after 5 years of follow-up, was estimated to be 0.41% (95% CI: 0.17-0.99%). The HCV incidence rate was calculated at 1.19 per 1,000 person-years (95% CI, 0.50-2.87). Conclusion Prevalence and incidence of HCV infection were substantial, estimated at ~5% and 1 per 1,000 person-years, respectively, and highlighting the presence of core groups actively engaged in the virus' acquisition and transmission. The high observed viremic rate indicates the need for expanding HCV treatment efforts to effectively control HCV transmission in Jordan. Utilizing quality diagnostic laboratories and innovative testing strategies is key to identifying infection carriers and facilitating linkage to treatment and care.
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Affiliation(s)
- Issa Abu-Dayyeh
- Department of Research and Development, Biolab Diagnostic Laboratories, Amman, Jordan
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Mohammad Ghunaim
- Department of Research and Development, Biolab Diagnostic Laboratories, Amman, Jordan
| | - Thaer Hasan
- Department of Research and Development, Biolab Diagnostic Laboratories, Amman, Jordan
| | - Amid Abdelnour
- Department of Research and Development, Biolab Diagnostic Laboratories, Amman, Jordan
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Osei-Yeboah J, Kengne AP, Owusu-Dabo E, Schulze MB, Meeks KA, Klipstein-Grobusch K, Smeeth L, Bahendeka S, Beune E, Moll van Charante EP, Agyemang C. Validation of prevalent diabetes risk scores based on non-invasively measured predictors in Ghanaian migrant and non-migrant populations - The RODAM study. PUBLIC HEALTH IN PRACTICE 2023; 6:100453. [PMID: 38034345 PMCID: PMC10687695 DOI: 10.1016/j.puhip.2023.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Background Non-invasive diabetes risk models are a cost-effective tool in large-scale population screening to identify those who need confirmation tests, especially in resource-limited settings. Aims This study aimed to evaluate the ability of six non-invasive risk models (Cambridge, FINDRISC, Kuwaiti, Omani, Rotterdam, and SUNSET model) to identify screen-detected diabetes (defined by HbA1c) among Ghanaian migrants and non-migrants. Study design A multicentered cross-sectional study. Methods This analysis included 4843 Ghanaian migrants and non-migrants from the Research on Obesity and Diabetes among African Migrants (RODAM) Study. Model performance was assessed using the area under the receiver operating characteristic curves (AUC), Hosmer-Lemeshow statistics, and calibration plots. Results All six models had acceptable discrimination (0.70 ≤ AUC <0.80) for screen-detected diabetes in the overall/combined population. Model performance did not significantly differ except for the Cambridge model, which outperformed Rotterdam and Omani models. Calibration was poor, with a consistent trend toward risk overestimation for screen-detected diabetes, but this was substantially attenuated by recalibration through adjustment of the original model intercept. Conclusion Though acceptable discrimination was observed, the original models were poorly calibrated among populations of African ancestry. Recalibration of these models among populations of African ancestry is needed before use.
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Affiliation(s)
- James Osei-Yeboah
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andre-Pascal Kengne
- Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ellis Owusu-Dabo
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam‐Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Germany
- Institute of Nutritional Science, University of Potsdam, Germany
| | - Karlijn A.C. Meeks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Liam Smeeth
- Department of Non‐Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Erik Beune
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Eric P. Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam Public health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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Doan L, Nguyen HT, Nguyen TTP, Phan TTL, Huy LD, Nguyen TTH, Doan TP. ModAsian FINDRISC as a Screening Tool for People with Undiagnosed Type 2 Diabetes Mellitus in Vietnam: A Community-Based Cross-Sectional Study. J Multidiscip Healthc 2023; 16:439-449. [PMID: 36814807 PMCID: PMC9940497 DOI: 10.2147/jmdh.s398455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Purpose Our study aims to evaluate the risk of developing type 2 diabetes mellitus in the next 10 years using ModAsian FINDRISC and additionally explore associated factors among the Vietnam population. Participants and Methods A cross-sectional study was conducted on 2258 participants aged 25 years old or above in Thua Thien Hue Province, Vietnam. The sample size is calculated based on the estimated sensitivity, and participants were randomly selected from different geographical and socio-economic areas. All participants were thoroughly medically examined, taking blood lipid profile and fasting blood glucose, taking blood pressure, anthropometric indexes, 12-lead electrocardiogram, and behavioral factors were investigated using the Vietnamese version of the WHO STEPS toolkit. The risk of developing T2DM was made based on the ModAsian FINDRISC. Results The incidence of developing type 2 diabetes mellitus among the study population was 4.21%. The group with a high or very high risk of developing type 2 diabetes mellitus in the next 10 years accounted for 2.52%. Body mass index (AUC = 0.840, 95% CI: 0.792-0.888), waist circumference (AUC = 0.824, 95% CI: 0.777-0.871), family history of diabetes mellitus (AUC = 0.751, 95% CI = 0.668-0.833), and history of antihypertensive medication use regularly (AUC = 0.708, 95% CI: 0.632-0.784) are the most associated factors of the ModAsian FINDRISC. Residential location (OR = 5.62, 95% CI: 1.91-16.54) and occupational status (OR = 0.35, 95% CI: 0.20-0.62) were significant factors associated with a high and very high risk of developing type 2 diabetes mellitus in the next 10 year. Conclusion Screening for the risk of type 2 diabetes mellitus and implementing intervention programs focusing on controlling weight, waist circumference, and blood pressure are essential for reducing type 2 diabetes mellitus incidence and burden in Vietnam.
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Affiliation(s)
- Long Doan
- Internal Medicine Department, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Huong T Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Thao T P Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Thi Thuy Linh Phan
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Le Duc Huy
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Thi Thuy Hang Nguyen
- Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam
| | - Thuoc Phuoc Doan
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, Vietnam,Correspondence: Thuoc Phuoc Doan, Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Thua Thien Hue, 53000, Vietnam, Tel +84 914932577, Email
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Rokhman MR, Arifin B, Zulkarnain Z, Satibi S, Perwitasari DA, Boersma C, Postma MJ, van der Schans J. Translation and performance of the Finnish Diabetes Risk Score for detecting undiagnosed diabetes and dysglycaemia in the Indonesian population. PLoS One 2022; 17:e0269853. [PMID: 35862370 PMCID: PMC9302803 DOI: 10.1371/journal.pone.0269853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
A diabetes risk score cannot directly be translated and applied in different populations, and its performance should be evaluated in the target population. This study aimed to translate the Finnish Diabetes Risk Score (FINDRISC) instrument and compare its performance with the modified version for detecting undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia among the Indonesian adult population. Forward and backward translations were performed and followed by cultural adaptation. In total, 1,403 participants were recruited. The FINDRISC-Bahasa Indonesia (FINDRISC-BI) was scored according to the original FINDRISC instrument, while a Modified FINDRISC-BI was analyzed using a specific body mass index and waist circumference classification for Indonesians. The area under the receiver operating characteristic curve, sensitivity, specificity, and the optimal cut-offs of both instruments were estimated. The area under the receiver operating characteristic curve for detecting undiagnosed T2DM was 0.73 (0.67-0.78) for the FINDRISC-BI with an optimal cut-off score of ≥9 (sensitivity = 63.0%; specificity = 67.3%) and 0.72 (0.67-0.78) for the Modified FINDRISC-BI with an optimal cut-off score of ≥11 (sensitivity = 59.8%; specificity = 74.9%). The area under the receiver operating characteristic curve for detecting dysglycaemia was 0.72 (0.69-0.75) for the FINDRISC-BI instrument with an optimal cut-off score of ≥8 (sensitivity = 66.4%; specificity = 67.0%), and 0.72 (0.69-0.75) for the Modified FINDRISC-BI instrument with an optimal cut-off score ≥9 (sensitivity = 63.8%; specificity = 67.6%). The Indonesian version of the FINDRISC instrument has acceptable diagnostic accuracy for screening people with undiagnosed T2DM or dysglycaemia in Indonesia. Modifying the body mass index and waist circumference classifications in the Modified FINDRISC-BI results in a similar diagnostic accuracy; however, the Modified FINDRISC-BI has a higher optimal cut-off point than the FINDRISC-BI. People with an above optimal cut-off score are suggested to take a further blood glucose test.
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Affiliation(s)
- M. Rifqi Rokhman
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bustanul Arifin
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Zulkarnain Zulkarnain
- Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Thyroid Center, Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Satibi Satibi
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Cornelis Boersma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Management Sciences, Open University, Heerlen, The Netherlands
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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Abu-Raddad LJ, Dargham S, Chemaitelly H, Coyle P, Al Kanaani Z, Al Kuwari E, Butt AA, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul Rahim HF, Nasrallah GK, Yassine HM, Al Kuwari MG, Al Romaihi HE, Al-Thani MH, Al Khal A, Bertollini R. COVID-19 risk score as a public health tool to guide targeted testing: A demonstration study in Qatar. PLoS One 2022; 17:e0271324. [PMID: 35853026 PMCID: PMC9295939 DOI: 10.1371/journal.pone.0271324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
We developed a Coronavirus Disease 2019 (COVID-19) risk score to guide targeted RT-PCR testing in Qatar. The Qatar national COVID-19 testing database, encompassing a total of 2,688,232 RT-PCR tests conducted between February 5, 2020-January 27, 2021, was analyzed. Logistic regression analyses were implemented to derive the COVID-19 risk score, as a tool to identify those at highest risk of having the infection. Score cut-off was determined using the ROC curve based on maximum sum of sensitivity and specificity. The score’s performance diagnostics were assessed. Logistic regression analysis identified age, sex, and nationality as significant predictors of infection and were included in the risk score. The ROC curve was generated and the area under the curve was estimated at 0.63 (95% CI: 0.63–0.63). The score had a sensitivity of 59.4% (95% CI: 59.1%-59.7%), specificity of 61.1% (95% CI: 61.1%-61.2%), a positive predictive value of 10.9% (95% CI: 10.8%-10.9%), and a negative predictive value of 94.9% (94.9%-95.0%). The concept and utility of a COVID-19 risk score were demonstrated in Qatar. Such a public health tool can have considerable utility in optimizing testing and suppressing infection transmission, while maximizing efficiency and use of available resources.
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Affiliation(s)
- Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, United States of America
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Soha Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, United States of America
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
| | | | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, United States of America
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | - Gheyath K Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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10
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Henjum S, Hjellset VT, Andersen E, Flaaten MØ, Morseth MS. Developing a risk score for undiagnosed prediabetes or type 2 diabetes among Saharawi refugees in Algeria. BMC Public Health 2022; 22:720. [PMID: 35410198 PMCID: PMC9004169 DOI: 10.1186/s12889-022-13007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS To prevent type 2 diabetes mellitus (T2D) and reduce the risk of complications, early identification of people at risk of developing T2D, preferably through simple diabetes risk scores, is essential. The aim of this study was to create a risk score for identifying subjects with undiagnosed prediabetes or T2D among Saharawi refugees in Algeria and compare the performance of this score to the Finnish diabetes risk score (FINDRISC). METHODS A cross-sectional survey was carried out in five Saharawi refugee camps in Algeria in 2014. A total of 180 women and 175 men were included. HbA1c and cut-offs proposed by the American Diabetes Association (ADA) were used to define cases. Variables to include in the risk score were determined by backwards elimination in logistic regression. Simplified scores were created based on beta coefficients from the multivariable model after internal validation with bootstrapping and shrinkage. The empirical cut-off value for the simplified score and FINDRISC was determined by Area Under the Receiver Operating Curve (AUROC) analysis. RESULTS Variables included in the final risk score were age, body mass index (BMI), and waist circumference. The area under the curve (AUC) (C.I) was 0.82 (0.76, 0.88). The sensitivity, specificity, and positive and negative predictive values were 89, 65, 28, and 97%, respectively. AUC and sensitivity were slightly higher and specificity somewhat lower than for FINDRISC. CONCLUSIONS The risk score developed is a helpful tool to decide who should be screened for prediabetes or T2D by blood sample analysis. The performance of the risk score was adequate based on internal validation with bootstrap analyses, but should be confirmed in external validation studies.
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Affiliation(s)
- Sigrun Henjum
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway
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11
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AIM in Endocrinology. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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12
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Quang Binh T, Tran Phuong P, Thanh Chung N, Thi Nhung B, Dinh Tung D, Tuan Linh D, Ngoc Luong T, Danh Tuyen L. A simple nomogram for identifying individuals at high risk of undiagnosed diabetes in rural population. Diabetes Res Clin Pract 2021; 180:109061. [PMID: 34597731 DOI: 10.1016/j.diabres.2021.109061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/21/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
AIMS To sought for an easily applicable nomogram for detecting individuals at high risk of undiagnosed type 2 diabetes. METHODS The development cohort included 2542 participants recruited randomly from a rural population in 2011.The glycemic status of subjects was determined using the fasting plasma glucose test and the oral glucose tolerance test. The Bayesian Model Average approach was used to search for a parsimonious model with minimum number of predictor and maximum discriminatory power. The corresponding prediction nomograms were constructed and checked for discrimination, calibration, clinical usefulness, and generalizability in nationwide population in 2012. RESULTS The non-lab nomogram including waist circumference and systolic blood pressure was the most parsimonious with the area under receiver operating characteristic curve (AUC) of 0.71 (95 %CI = 0.64-0.76). Adding low-density lipoprotein cholesterol in the non-lab nomogram generated the lab-based nomogram with significantly improved AUC of 0.83 (0.78-0.87, P < 0.001). The nomograms had a positive net benefit at threshold probability between 0.01 and 0.15. Applying the non-lab nomogram to the national population yielded the AUC of 0.66 (0.63-0.70) and 0.68 (0.65-0.71) in the cohorts aged 40-64 and 30-69 years, respectively. CONCLUSIONS The novel nomograms could help promote the early detection of undiagnosed diabetes in rural Vietnamese population.
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Affiliation(s)
- Tran Quang Binh
- National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam; Dinh Tien Hoang Institute of Medicine, 20 Cat Linh, Dong Da, Hanoi, Vietnam.
| | - Pham Tran Phuong
- National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam
| | - Nguyen Thanh Chung
- National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi, Vietnam
| | - Bui Thi Nhung
- National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam
| | - Do Dinh Tung
- National Institute of Diabetes and Metabolic Disorders, 1 Ton That Tung, Hanoi, Vietnam
| | - Duong Tuan Linh
- National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam
| | - Tran Ngoc Luong
- National Hospital of Endocrinology, 80, Alley 82, Yen Lang Street, Dong Da District, Hanoi, Vietnam
| | - Le Danh Tuyen
- National Institute of Nutrition, 48B Tang Bat Ho Street, Hanoi, Vietnam
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13
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Liu H, Li J, Leng J, Wang H, Liu J, Li W, Liu H, Wang S, Ma J, Chan JC, Yu Z, Hu G, Li C, Yang X. Machine learning risk score for prediction of gestational diabetes in early pregnancy in Tianjin, China. Diabetes Metab Res Rev 2021; 37:e3397. [PMID: 32845061 DOI: 10.1002/dmrr.3397] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/21/2020] [Accepted: 08/01/2020] [Indexed: 12/18/2022]
Abstract
AIMS This study aimed to develop a machine learning-based prediction model for gestational diabetes mellitus (GDM) in early pregnancy in Chinese women. MATERIALS AND METHODS We used an established population-based prospective cohort of 19,331 pregnant women registered as pregnant before the 15th gestational week in Tianjin, China, from October 2010 to August 2012. The dataset was randomly divided into a training set (70%) and a test set (30%). Risk factors collected at registration were examined and used to construct the prediction model in the training dataset. Machine learning, that is, the extreme gradient boosting (XGBoost) method, was employed to develop the model, while a traditional logistic model was also developed for comparison purposes. In the test dataset, the performance of the developed prediction model was assessed by calibration plots for calibration and area under the receiver operating characteristic curve (AUR) for discrimination. RESULTS In total, 1484 (7.6%) women developed GDM. Pre-pregnancy body mass index, maternal age, fasting plasma glucose at registration, and alanine aminotransferase were selected as risk factors. The machine learning XGBoost model-predicted probability of GDM was similar to the observed probability in the test data set, while the logistic model tended to overestimate the risk at the highest risk level (Hosmer-Lemeshow test p value: 0.243 vs. 0.099). The XGBoost model achieved a higher AUR than the logistic model (0.742 vs. 0.663, p < 0.001). This XGBoost model was deployed through a free, publicly available software interface (https://liuhongwei.shinyapps.io/gdm_risk_calculator/). CONCLUSION The XGBoost model achieved better performance than the logistic model.
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Affiliation(s)
- Hongwei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Hui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jinnan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Hongyan Liu
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Shuo Wang
- Tianjin Women and Children's Health Center, Tianjin, China
| | - Jun Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Juliana Cn Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
- International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhijie Yu
- Population Cancer Research Program and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Vangeepuram N, Liu B, Chiu PH, Wang L, Pandey G. Predicting youth diabetes risk using NHANES data and machine learning. Sci Rep 2021; 11:11212. [PMID: 34045491 PMCID: PMC8160335 DOI: 10.1038/s41598-021-90406-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06-0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10-5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.
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Affiliation(s)
- Nita Vangeepuram
- Division of General Pediatrics, Department of Pediatrics, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Po-Hsiang Chiu
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Linhua Wang
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences and Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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15
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Lee S, Washburn DJ, Colwell B, Gwarzo IH, Kellstedt D, Ahenda P, Maddock JE. Examining social determinants of undiagnosed diabetes in Namibia and South Africa using a behavioral model of health services use. Diabetes Res Clin Pract 2021; 175:108814. [PMID: 33872630 DOI: 10.1016/j.diabres.2021.108814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/27/2021] [Accepted: 04/08/2021] [Indexed: 01/21/2023]
Abstract
AIMS To examine factors associated with undiagnosed diabetes in Namibia and South Africa. METHODS This study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35-64 years old. Using Andersen's Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N = 242) and South Africa (N = 525). RESULTS In Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR) = 2.21) and age younger than 45 years old (aOR = 3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR = 2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR = 0.31 in Namibia; aOR = 0.21 in South Africa). DISCUSSION Different enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.
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Affiliation(s)
- Shinduk Lee
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA.
| | - David J Washburn
- Department of Health Policy and Management, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Brian Colwell
- Department of Health Promotion and Community Health Sciences, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Ibrahim H Gwarzo
- Department of Epidemiology & Biostatistics, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Debra Kellstedt
- Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Petronella Ahenda
- Department of Public Health Studies, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
| | - Jay E Maddock
- Department of Environmental and Occupational Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, USA
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Performance of Risk Assessment Models for Prevalent or Undiagnosed Type 2 Diabetes Mellitus in a Multi-Ethnic Population-The Helius Study. Glob Heart 2021; 16:13. [PMID: 33598393 PMCID: PMC7880001 DOI: 10.5334/gh.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Most risk assessment models for type 2 diabetes (T2DM) have been developed in Caucasians and Asians; little is known about their performance in other ethnic groups. Objective(s): We aimed to identify existing models for the risk of prevalent or undiagnosed T2DM and externally validate them in a multi-ethnic population currently living in the Netherlands. Methods: A literature search to identify risk assessment models for prevalent or undiagnosed T2DM was performed in PubMed until December 2017. We validated these models in 4,547 Dutch, 3,035 South Asian Surinamese, 4,119 African Surinamese, 2,326 Ghanaian, 3,598 Turkish, and 3,894 Moroccan origin participants from the HELIUS (Healthy LIfe in an Urban Setting) cohort study performed in Amsterdam. Model performance was assessed in terms of discrimination (C-statistic) and calibration (Hosmer-Lemeshow test). We identified 25 studies containing 29 models for prevalent or undiagnosed T2DM. C-statistics varied between 0.77–0.92 in Dutch, 0.66–0.83 in South Asian Surinamese, 0.70–0.82 in African Surinamese, 0.61–0.81 in Ghanaian, 0.69–0.86 in Turkish, and 0.69–0.87 in the Moroccan populations. The C-statistics were generally lower among the South Asian Surinamese, African Surinamese, and Ghanaian populations and highest among the Dutch. Calibration was poor (Hosmer-Lemeshow p < 0.05) for all models except one. Conclusions: Generally, risk models for prevalent or undiagnosed T2DM show moderate to good discriminatory ability in different ethnic populations living in the Netherlands, but poor calibration. Therefore, these models should be recalibrated before use in clinical practice and should be adapted to the situation of the population they are intended to be used in.
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17
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Awad SF, Dargham SR, Toumi AA, Dumit EM, El-Nahas KG, Al-Hamaq AO, Critchley JA, Tuomilehto J, Al-Thani MHJ, Abu-Raddad LJ. A diabetes risk score for Qatar utilizing a novel mathematical modeling approach to identify individuals at high risk for diabetes. Sci Rep 2021; 11:1811. [PMID: 33469048 PMCID: PMC7815783 DOI: 10.1038/s41598-021-81385-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022] Open
Abstract
We developed a diabetes risk score using a novel analytical approach and tested its diagnostic performance to detect individuals at high risk of diabetes, by applying it to the Qatari population. A representative random sample of 5,000 Qataris selected at different time points was simulated using a diabetes mathematical model. Logistic regression was used to derive the score using age, sex, obesity, smoking, and physical inactivity as predictive variables. Performance diagnostics, validity, and potential yields of a diabetes testing program were evaluated. In 2020, the area under the curve (AUC) was 0.79 and sensitivity and specificity were 79.0% and 66.8%, respectively. Positive and negative predictive values (PPV and NPV) were 36.1% and 93.0%, with 42.0% of Qataris being at high diabetes risk. In 2030, projected AUC was 0.78 and sensitivity and specificity were 77.5% and 65.8%. PPV and NPV were 36.8% and 92.0%, with 43.0% of Qataris being at high diabetes risk. In 2050, AUC was 0.76 and sensitivity and specificity were 74.4% and 64.5%. PPV and NPV were 40.4% and 88.7%, with 45.0% of Qataris being at high diabetes risk. This model-based score demonstrated comparable performance to a data-derived score. The derived self-complete risk score provides an effective tool for initial diabetes screening, and for targeted lifestyle counselling and prevention programs.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, USA
| | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | - Amine A Toumi
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | | | | | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar. .,World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar. .,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, USA.
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Hong N, Park Y, You SC, Rhee Y. AIM in Endocrinology. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Mugeni R, Hormenu T, Hobabagabo A, Shoup EM, DuBose CW, Sumner AE, Horlyck-Romanovsky MF. Identifying Africans with undiagnosed diabetes: Fasting plasma glucose is similar to the hemoglobin A1C updated Atherosclerosis Risk in Communities diabetes prediction equation. Prim Care Diabetes 2020; 14:501-507. [PMID: 32173292 DOI: 10.1016/j.pcd.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
AIMS Seventy percent of Africans living with diabetes are undiagnosed. Identifying who should be referred for testing is critical. Therefore we evaluated the ability of the Atherosclerosis Risk in Communities (ARIC) diabetes prediction equation with A1C added (ARIC + A1C) to identify diabetes in 451 African-born blacks living in America (66% male; age 38 ± 10y (mean ± SD); BMI 27.5 ± 4.4 kg/m2). METHODS All participants denied a history of diabetes. OGTTs were performed. Diabetes diagnosis required 2-h glucose ≥200 mg/dL. The five non-invasive (Age, parent history of diabetes, waist circumference, height, systolic blood pressure) and four invasive variables (Fasting glucose (FPG), A1C, triglycerides (TG), HDL) were obtained. Four models were tested: Model-1: Full ARIC + A1C equation; Model-2: All five non-invasive variables with one invasive variable excluded at a time; Model-3: All five non-invasive variables with one invasive variable included at a time; Model-4: Each invasive variable singly. Area under the receiver operator characteristic curve (AROC) predicted diabetes. Youden Index identified optimal cut-points. RESULTS Diabetes occurred in 7% (30/451). Model-1, the full ARIC + A1C equation, AROC = 0.83. Model-2: With FPG excluded, AROC = 0.77 (P = 0.038), but when A1C, HDL or TG were excluded AROC remained unchanged. Model-3 with all non-invasive variables and FPG alone, AROC=0.87; but with A1C, TG or HDL included AROC declined to ≤0.76. Model-4: FPG as a single predictor, AROC = 0.87. A1C, TG, or HDL as single predictors all had AROC ≤ 0.74. Optimal cut-point for FPG was 100 mg/dL. CONCLUSIONS To detect diabetes, FPG performed as well as the nine-variable updated ARIC + A1C equation.
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Affiliation(s)
- Regine Mugeni
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Thomas Hormenu
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Arsène Hobabagabo
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Elyssa M Shoup
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Christopher W DuBose
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Anne E Sumner
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; National Institute of Minority Health and Health Disparities (NIMHD), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States
| | - Margrethe F Horlyck-Romanovsky
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, United States; City University of New York, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY, United States.
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20
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Li Y, Jiang H, Cheng M, Yao W, Zhang H, Shi Y, Xu W. Performance and costs of multiple screening strategies for type 2 diabetes: two population-based studies in Shanghai, China. BMJ Open Diabetes Res Care 2020; 8:8/1/e001569. [PMID: 32816870 PMCID: PMC7437878 DOI: 10.1136/bmjdrc-2020-001569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION To compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population. RESEARCH DESIGN AND METHODS Two multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed. RESULTS Of numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L. CONCLUSIONS Our results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening.
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Affiliation(s)
- Yanyun Li
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huiru Jiang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
| | - Minna Cheng
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Weiyuan Yao
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
| | - Hua Zhang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment (National Health Commission), Fudan University, Shanghai, China
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Félix-Martínez GJ, Godínez-Fernández JR. Comparative analysis of screening models for undiagnosed diabetes in Mexico. ENDOCRINOL DIAB NUTR 2020; 67:333-341. [PMID: 31796340 DOI: 10.1016/j.endinu.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND It is estimated that 37% of Mexican adults have undiagnosed diabetes, and are therefore at high risk of developing the severe and devastating complications associated to it. In recent years, a variety of screening tools based on the characteristics of the adult Mexican population have been proposed in order to reduce the negative effects of the disease. OBJECTIVES To assess the performance of screening models to diagnose diabetes in the Mexican adult population and to propose a screening model based on HbA1c measurements. MATERIALS AND METHODS Data from the 2016 Halfway National Health and Nutrition Survey (NHNS) were used to assess the screening models and to develop and validate the proposed 2016 NHNS model, built using a multivariate logistic regression model. Explanatory variables included in the 2016 NHNS 2016 model were selected through a stepwise backward procedure, using sensitivity and specificity as performance indicators. RESULTS Of the screening models assessed, only the model based on the 2006 NHNS survey showed a performance consistent with previous reports. The proposed 2016 NHNS model included age, waist circumference, and systolic blood pressure as explanatory variables and showed a sensitivity of 0.72 and a specificity of 0.80 in the validation data set. CONCLUSIONS Age, waist circumference, and systolic blood pressure are variables of special importance for early detection of undiagnosed diabetes in Mexican adults. Based on the consistent performance of the 2006 NHNS model in different data sets, its use as a screening tool for adults with undiagnosed diabetes in Mexico is recommended.
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Affiliation(s)
- Gerardo Jorge Félix-Martínez
- Cátedras CONACYT (Consejo Nacional de Ciencia y Tecnología, México), Mexico; Departamento de Ingeniería Eléctrica, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico.
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Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082876. [PMID: 32326364 PMCID: PMC7215538 DOI: 10.3390/ijerph17082876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
Completed and ongoing implementation activities globally advocate for community-based approaches to improve strategies for type 2 diabetes prevention. However, little is known about such strategies in the African region where there are higher relative increases in diabetes prevalence. We reported findings from the first 8-month pilot phase of the South African diabetes prevention program. The study was conducted across eight townships (four black and four mixed-ancestry communities) in Cape Town, South Africa, between August 2017 and March 2018. Participants were recruited using both random and self-selected sampling techniques because the former approach proved to be ineffective; <10% of randomly selected individuals consented to participate. Non-laboratory-based diabetes risk screening, using the African diabetes risk score, and based on targeted population specific cut-offs, identified potentially high-risk adults in the community. This was followed by an oral glucose tolerance test (OGTT) to confirm prevalent pre-diabetes. Among the 853 adults without prior diabetes who were screened in the community, 354 (43.4%) were classified as high risk, and 316 presented for further screening. On OGTT, 13.1% had dysglycemia, including 10% with screen-detected diabetes and 67.9% with glycated haemoglobin (HbA1c)-defined high risk. Participants with pre-diabetes (n = 208) had high levels of common cardiovascular risk factors, i.e., obesity (73.7%), elevated total cholesterol (51.9%), and hypertension (29.4%). Self-referral is likely an efficient method for selecting participants for community-based diabetes risk screening in Africa. Post-screening management of individuals with pre-diabetes must include attention to co-morbid cardiovascular risk factors.
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Abstract
PURPOSE OF REVIEW Machine learning (ML) is increasingly being studied for the screening, diagnosis, and management of diabetes and its complications. Although various models of ML have been developed, most have not led to practical solutions for real-world problems. There has been a disconnect between ML developers, regulatory bodies, health services researchers, clinicians, and patients in their efforts. Our aim is to review the current status of ML in various aspects of diabetes care and identify key challenges that must be overcome to leverage ML to its full potential. RECENT FINDINGS ML has led to impressive progress in development of automated insulin delivery systems and diabetic retinopathy screening tools. Compared with these, use of ML in other aspects of diabetes is still at an early stage. The Food & Drug Administration (FDA) is adopting some innovative models to help bring technologies to the market in an expeditious and safe manner. ML has great potential in managing diabetes and the future is in furthering the partnership of regulatory bodies with health service researchers, clinicians, developers, and patients to improve the outcomes of populations and individual patients with diabetes.
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Affiliation(s)
- David T Broome
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, F-20 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - C Beau Hilton
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Neil Mehta
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, EC-40 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Abdallah M, Sharbaji S, Sharbaji M, Daher Z, Faour T, Mansour Z, Hneino M. Diagnostic accuracy of the Finnish Diabetes Risk Score for the prediction of undiagnosed type 2 diabetes, prediabetes, and metabolic syndrome in the Lebanese University. Diabetol Metab Syndr 2020; 12:84. [PMID: 33014142 PMCID: PMC7526372 DOI: 10.1186/s13098-020-00590-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/19/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Risk scores were mainly proved to predict undiagnosed type 2 diabetes mellitus (UT2DM) in a non-invasive manner and to guide earlier clinical treatment. The objective of the present study was to assess the performance of the Finnish Diabetes Risk Score (FINDRISC) for detecting three outcomes: UT2DM, prediabetes, and the metabolic syndrome (MS). METHODS This was a prospective, cross-sectional study during which employees aged between 30 and 64, with no known diabetes and working within the faculties of the Lebanese University (LU) were conveniently recruited. Participants completed the FINDRISC questionnaire and their glucose levels were examined using both fasting blood glucose (FBG) and oral glucose tolerance tests (OGTT). Furthermore, they underwent lipid profile tests with anthropometry. RESULTS Of 713 subjects, 397 subjects (55.2% female; 44.8% male) completed the blood tests and thus were considered as the sample population. 7.6% had UT2DM, 22.9% prediabetes and 35.8% had MS, where men had higher prevalence than women for these 3 outcomes (P = 0.001, P = 0.003 and P = 0.001) respectively. The AUROC value with 95% Confidence Interval (CI) for detecting UT2DM was 0.795 (0.822 in men and 0.725 in women), 0.621(0.648 in men and 0.59 in women) for prediabetes and 0.710 (0.734 in men and 0.705 in women) for MS. The correspondent optimal cut-off point for UT2DM was 11.5 (sensitivity = 83.3% and specificity = 61.3%), 9.5 for prediabetes (sensitivity = 73.6% and specificity = 43.1%) and 10.5 (sensitivity = 69.7%; specificity = 56.5%) for MS. CONCLUSION The FINDRISC can be considered a simple, quick, inexpensive, and non-invasive instrument to use in a Lebanese community of working people who are unaware of their health status and who usually report being extremely busy because of their daily hectic work for the screening of UT2DM and MS. However, it poorly screens for prediabetes in this context.
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Affiliation(s)
- Maher Abdallah
- Faculty of Public Health, Lebanese University, Hadat, Beirut, Lebanon
| | - Safa Sharbaji
- Department of Nutrition and Dietetics, Faculty of Public Health, Lebanese University, Hadat, Beirut, Lebanon
| | - Marwa Sharbaji
- Department of Nutrition and Dietetics, Faculty of Public Health, Lebanese University, Hadat, Beirut, Lebanon
| | - Zeina Daher
- Faculty of Public Health, Lebanese University, Hadat, Beirut, Lebanon
| | - Tarek Faour
- Medical Laboratory, Lebanese University Medical Center, Lebanese University, Hadat, Beirut, Lebanon
| | - Zeinab Mansour
- Medical Laboratory, Lebanese University Medical Center, Lebanese University, Hadat, Beirut, Lebanon
| | - Mohammad Hneino
- Sciences Department, Faculty of Public Health, Lebanese University Hadat, Hadat, Beirut, Lebanon
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Mitchell AJ, Vancampfort D, Manu P, Correll CU, Wampers M, van Winkel R, Yu W, De Hert M. Which clinical and biochemical predictors should be used to screen for diabetes in patients with serious mental illness receiving antipsychotic medication? A large observational study. PLoS One 2019; 14:e0210674. [PMID: 31513598 PMCID: PMC6742458 DOI: 10.1371/journal.pone.0210674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/28/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We aimed to investigate which clinical and metabolic tests offer optimal accuracy and acceptability to help diagnose diabetes among a large sample of people with serious mental illness in receipt of antipsychotic medication. METHODS A prospective observational study design of biochemical and clinical factors was used. Biochemical measures were fasting glucose, insulin and lipids, oral glucose tolerance testing (OGTT), hemoglobin A1c, and insulin resistance assessed with the homeostatic model (HOMA-IR) were determined in a consecutive cohort of 798 adult psychiatric inpatients receiving antipsychotics. Clinical variables were gender, age, global assessment of functioning (GAF), mental health clinicians' global impression (CGI), duration of severe mental illness, height, weight, BMI and waist/hip ratio. In addition, we calculated the risk using combined clinical predictors using the Leicester Practice Risk Score (LPRS) and the Topics Diabetes Risk Score (TDRS). Diabetes was defined by older criteria (impaired fasting glucose (IFG) or OGTT) as well as2010 criteria (IFG or OGTT or Glycated haemoglobin (HBA1c)) at conventional cut-offs. RESULTS Using the older criteria, 7.8% had diabetes (men: 6.3%; women: 10.3%). Using the new criteria, 10.2% had diabetes (men: 8.2%, women: 13.2%), representing a 30.7% increase (p = 0.02) in the prevalence of diabetes. Regarding biochemical predictors, conventional OGTT, IFG, and HbA1c thresholds used to identify newly defined diabetes missed 25%, 50% and 75% of people with diabetes, respectively. The conventional HBA1c cut-point of ≥6.5% (48 mmol/mol) missed 7 of 10 newly defined cases of diabetes while a cut-point of ≥5.7% improved sensitivity from 44.4% to up to 85%. Specific algorithm approaches offered reasonable accuracy. Unfortunately no single clinical factor was able to accurately rule-in a diagnosis of diabetes. Three clinical factors were able to rule-out diabetes with good accuracy namely: BMI, waist/hip ratio and height. A BMI < 30 had a 92% negative predictive value in ruling-out diabetes. Of those not diabetic, 20% had a BMI ≥ 30. However, for complete diagnosis a specific biochemical protocol is still necessary. CONCLUSIONS Patients with SMI maintained on antipsychotic medication cannot be reliably screened for diabetes using clinical variables alone. Accurate assessment requires a two-step algorithm consisting of HBA1c ≥5.7% followed by both FG and OGTT which does not require all patients to have OGTT and FG.
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Affiliation(s)
| | - Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Peter Manu
- University Psychiatric Center, Kortenberg, Belgium
- School of Mental Health and Neuroscience (EURON), University Medical Center, Maastricht, The Netherlands
| | - Christoph U. Correll
- Zucker Hillside Hospital, Glen Oaks, New York, United States
- Hofstra North Shore–LIJ School of Medicine, Hempstead, New York, United States
| | - Martien Wampers
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Ruud van Winkel
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Weiping Yu
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
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Mavrogianni C, Lambrinou CP, Androutsos O, Lindström J, Kivelä J, Cardon G, Huys N, Tsochev K, Iotova V, Chakarova N, Rurik I, Moreno LA, Liatis S, Makrilakis K, Manios Y. Evaluation of the Finnish Diabetes Risk Score as a screening tool for undiagnosed type 2 diabetes and dysglycaemia among early middle-aged adults in a large-scale European cohort. The Feel4Diabetes-study. Diabetes Res Clin Pract 2019; 150:99-110. [PMID: 30796939 DOI: 10.1016/j.diabres.2019.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 12/13/2022]
Abstract
AIM To assess the diagnostic accuracy of the FINDRISC for undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia (i.e. the presence of prediabetes or T2DM) among early middle-aged adults from vulnerable groups in a large-scale European cohort. METHODS Participants were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland) and in HICs under austerity measures (Greece-Spain) and from the overall population in low/middle-income countries (LMICs) (Bulgaria-Hungary). Study population comprised of 2116 parents of primary-school children from families identified at increased risk of T2DM, based on parental self-reported FINDRISC. Sensitivity (Se), specificity (Sp), area under the receiver operating characteristic curves (AUC-ROC) and the optimal cut-offs of FINDRISC that indicate an increased probability for undiagnosed T2DM or dysglycaemia were calculated. RESULTS The AUC-ROC for undiagnosed T2DM was 0.824 with optimal cut-off ≥14 (Se = 68%, Sp = 81.7%) for the total sample, 0.839 with optimal cut-off ≥15 (Se = 83.3%, Sp = 86.9%) for HICs, 0.794 with optimal cut-off ≥12 (Se = 83.3%, Sp = 61.1%) for HICs under austerity measures and 0.882 with optimal cut-off ≥14 (Se = 71.4%, Sp = 87.8%) for LMICs. The AUC-ROC for dysglycaemia was 0.663 with optimal cut-off ≥12 (Se = 58.3%, Sp = 65.7%) for the total sample, 0.656 with optimal cut-off ≥12 (Se = 54.5%, Sp = 64.8%) for HICs, 0.631 with optimal cut-off ≥12 (Se = 59.7%, Sp = 62.0%) for HICs under austerity measures and 0.735 with optimal cut-off ≥11 (Se = 72.7%, Sp = 70.2%) for LMICs. CONCLUSION FINDRISC can be applied for screening primarily undiagnosed T2DM but also dysglycaemia among vulnerable groups across Europe, considering the use of different cut-offs for each subpopulation.
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Affiliation(s)
- Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jemina Kivelä
- National Institute for Health and Welfare, Helsinki, Finland
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Nele Huys
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Imre Rurik
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
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Masconi KL, Matsha TE, Erasmus RT, Kengne AP. Effect of model updating strategies on the performance of prevalent diabetes risk prediction models in a mixed-ancestry population of South Africa. PLoS One 2019; 14:e0211528. [PMID: 30730899 PMCID: PMC6366743 DOI: 10.1371/journal.pone.0211528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background Prediction model updating methods are aimed at improving the prediction performance of a model in a new setting. This study sought to critically assess the impact of updating techniques when applying existent prevalent diabetes prediction models to a population different to the one in which they were developed, evaluating the performance in the mixed-ancestry population of South Africa. Methods The study sample consisted of 1256 mixed-ancestry individuals from the Cape Town Bellville-South cohort, of which 173 were excluded due to previously diagnosed diabetes and 162 individuals had undiagnosed diabetes. The primary outcome, undiagnosed diabetes, was based on an oral glucose tolerance test. Model updating techniques and prediction models were identified via recent systematic reviews. Model performance was assessed using the C-statistic and expected/observed (E/O) events rates ratio. Results Intercept adjustment and logistic calibration improved calibration across all five models (Cambridge, Kuwaiti, Omani, Rotterdam and Simplified Finnish diabetes risk models). This was improved further by model revision, where likelihood ratio tests showed that the effect of body mass index, waist circumference and family history of diabetes required additional adjustment (Omani, Rotterdam and Finnish models). However, discrimination was poor following internal validation of these models. Re-estimation of the regression coefficients did not increase performance, while the addition of new variables resulted in the highest discriminatory and calibration performance combination for the models it was undertaken in. Conclusions While the discriminatory performance of the original existent models during external validation were higher, calibration was poor. The highest performing models, based on discrimination and calibration, were the Omani diabetes model following model revision, and the Cambridge diabetes risk model following the addition of waist circumference as a predictor. However, while more extensive methods incorporating development population information were superior over simpler methods, the increase in model performance was not great enough for recommendation.
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Affiliation(s)
- Katya L. Masconi
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tandi E. Matsha
- Department of Biomedical Technology, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T. Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Bernabe-Ortiz A, Perel P, Miranda JJ, Smeeth L. Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population. Prim Care Diabetes 2018; 12:517-525. [PMID: 30131300 PMCID: PMC6249987 DOI: 10.1016/j.pcd.2018.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
AIMS To assess the diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM and to compare its performance with the Latin-American FINDRISC (LA-FINDRISC) and the Peruvian Risk Score. MATERIALS AND METHODS A population-based study was conducted. T2DM and undiagnosed T2DM were defined using oral glucose tolerance test (OGTT). Risk scores assessed were FINDRISC, LA-FINDRISC and Peruvian Risk Score. Diagnostic accuracy of risk scores was estimated using the c-statistic and the area under the ROC curve (aROC). A simplified version of FINDRISC was also derived. RESULTS Data from 1609 individuals, mean age 48.2 (SD: 10.6), 810 (50.3%) women, were collected. A total of 176 (11.0%; 95%CI: 9.4%-12.5%) were classified as having T2DM, and 71 (4.7%; 95%CI: 3.7%-5.8%) were classified as having undiagnosed T2DM. Diagnostic accuracy of the FINDRISC (aROC=0.69), LA-FINDRISC (aROC=0.68), and Peruvian Risk Score (aROC=0.64) was similar (p=0.15). The simplified FINDRISC, with 4 variables, had a slightly better performance (aROC=0.71) than the other scores. CONCLUSION The performance of FINDRISC, LA-FINDRISC and Peruvian Risk Score for undiagnosed T2DM was similar. A simplified FINDRISC can perform as well or better for undiagnosed T2DM. The FINDRISC may be useful to detect cases of undiagnosed T2DM in resource-constrained settings.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 18, Peru; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Juan Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 18, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 31, Peru.
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Nombo AP, Mwanri AW, Brouwer-Brolsma EM, Ramaiya KL, Feskens EJM. Gestational diabetes mellitus risk score: A practical tool to predict gestational diabetes mellitus risk in Tanzania. Diabetes Res Clin Pract 2018; 145:130-137. [PMID: 29852237 DOI: 10.1016/j.diabres.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Universal screening for hyperglycemia during pregnancy may be in-practical in resource constrained countries. Therefore, the aim of this study was to develop a simple, non-invasive practical tool to predict undiagnosed Gestational diabetes mellitus (GDM) in Tanzania. METHODS We used cross-sectional data of 609 pregnant women, without known diabetes, collected in six health facilities from Dar es Salaam city (urban). Women underwent screening for GDM during ante-natal clinics visit. Smoking habit, alcohol consumption, pre-existing hypertension, birth weight of the previous child, high parity, gravida, previous caesarean section, age, MUAC ≥ 28 cm, previous stillbirth, haemoglobin level, gestational age (weeks), family history of type 2 diabetes, intake of sweetened drinks (soda), physical activity, vegetables and fruits consumption were considered as important predictors for GDM. Multivariate logistic regression modelling was used to create the prediction model, using a cut-off value of 2.5 to minimise the number of undiagnosed GDM (false negatives). RESULTS Mid-upper arm circumference (MUAC) ≥ 28 cm, previous stillbirth, and family history of type 2 diabetes were identified as significant risk factors of GDM with a sensitivity, specificity, positive predictive value, and negative predictive value of 69%, 53%, 12% and 95%, respectively. Moreover, the inclusion of these three predictors resulted in an area under the curve (AUC) of 0.64 (0.56-0.72), indicating that the current tool correctly classifies 64% of high risk individuals. CONCLUSION The findings of this study indicate that MUAC, previous stillbirth, and family history of type 2 diabetes significantly predict GDM development in this Tanzanian population. However, the developed non-invasive practical tool to predict undiagnosed GDM only identified 6 out of 10 individuals at risk of developing GDM. Thus, further development of the tool is warranted, for instance by testing the impact of other known risk factors such as maternal age, pre-pregnancy BMI, hypertension during or before pregnancy and pregnancy weight gain.
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Affiliation(s)
- Anna Patrick Nombo
- Sokoine University of Agriculture, Department of Food Technology, Nutrition and Consumer Sciences, P.O. Box 3006, Morogoro, Tanzania
| | - Akwilina Wendelin Mwanri
- Sokoine University of Agriculture, Department of Food Technology, Nutrition and Consumer Sciences, P.O. Box 3006, Morogoro, Tanzania.
| | - Elske M Brouwer-Brolsma
- Wageningen University and Research Centre, Division of Human Nutrition, Wageningen, The Netherlands
| | | | - Edith J M Feskens
- Wageningen University and Research Centre, Division of Human Nutrition, P.O. Box 17, 6700AA Wageningen, The Netherlands
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Cosansu G, Celik S, Özcan S, Olgun N, Yıldırım N, Gulyuz Demir H. Determining type 2 diabetes risk factors for the adults: A community based study from Turkey. Prim Care Diabetes 2018; 12:409-415. [PMID: 29804712 DOI: 10.1016/j.pcd.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to determine risk factors for type 2 diabetes among adults who were not diagnosed with diabetes. METHODS Adults were included in this study within the public activities performed on World Diabetes Day (n=1872). Data were collected using the FINDRISC questionnaire and a short questionnaire. RESULTS Participants' mean age was 39.35±10.40. The mean FINDRISC score was 7.46±4.62, women's mean score was higher than that for men. The FINDRISC score indicates that 7.4% of the participants were in the highrisk group. Among participants, BMI value of 65.1% was 25kg/m2 and higher, waist circumference of 58% was over the threshold value; and 50.7% did not engage in sufficient physical activity. Of the participants, 9.5% had a history of high blood glucose, families of 38.9% had a history of diabetes. The mean FINDRISC score was in the slightly high category, 121 participants were found likely to be diagnosed with diabetes within ten years if no action was taken. CONCLUSIONS It is recommended the risk screening studies to be conducted and the FINDRISC tool to be used in Turkey, where diabetes prevalence is increasing rapidly, to determine diabetes risks in the early period and to raise social awareness for diabetes.
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Affiliation(s)
- Gulhan Cosansu
- Istanbul University Florence Nightingale Faculty of Nursing, Public Health Nursing Department, Istanbul, Turkey.
| | - Selda Celik
- Saglik Bilimleri University, Faculty of Nursing, Istanbul, Turkey
| | - Seyda Özcan
- Koc University School of Nursing Vehbi Koc Foundation Health Institutions, Istanbul, Turkey
| | - Nermin Olgun
- Hasan Kalyoncu University Faculty of Health Science Nursing Department, Gaziantep, Turkey
| | - Nurdan Yıldırım
- Ministry of Health, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
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Grint D, Alisjhabana B, Ugarte-Gil C, Riza AL, Walzl G, Pearson F, Ruslami R, Moore DAJ, Ioana M, McAllister S, Ronacher K, Koeseomadinata RC, Kerry-Barnard SR, Coronel J, Malherbe ST, Dockrell HM, Hill PC, Van Crevel R, Critchley JA. Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa. Bull World Health Organ 2018; 96:738-749. [PMID: 30455529 PMCID: PMC6239004 DOI: 10.2471/blt.17.206227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries. Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L. Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6–14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75–0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81–0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru. Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation.
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Affiliation(s)
- Daniel Grint
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England
| | - Bachti Alisjhabana
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Cesar Ugarte-Gil
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Anca-Leila Riza
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerhard Walzl
- Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Fiona Pearson
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - David A J Moore
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Mihai Ioana
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Craiova, Romania
| | - Susan McAllister
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Katharina Ronacher
- Mater Medical Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Raspati C Koeseomadinata
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sarah R Kerry-Barnard
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
| | - Jorge Coronel
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Stephanus T Malherbe
- Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, England
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
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Juarez LD, Gonzalez JS, Agne AA, Kulczycki A, Pavela G, Carson AP, Shelley JP, Cherrington AL. Diabetes risk scores for Hispanics living in the United States: A systematic review. Diabetes Res Clin Pract 2018; 142:120-129. [PMID: 29852236 PMCID: PMC6557572 DOI: 10.1016/j.diabres.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/17/2018] [Accepted: 05/08/2018] [Indexed: 12/21/2022]
Abstract
AIM Undiagnosed diabetes is more prevalent among racial/ethnic minorities in the United States (U.S.). Despite the proliferation of risk scores, few have been validated in Hispanics populations. The aim of this study is to systematically review published studies that developed risk scores to identify undiagnosed Type 2 Diabetes Mellitus based on self-reported information that were validated for Hispanics in the U.S. METHODS The search included PubMed, EMBASE, Cochrane and CINAHL from inception to 2016 without language restrictions. Risk scores whose main outcome was undiagnosed Type 2 diabetes reporting performance measures for Hispanics were included. RESULTS We identified three studies that developed and validated risk scores for undiagnosed diabetes based on questionnaire data. Two studies were conducted in Latin America and one in the U.S. All three studies reported adequate performance (area under the receiving curve (AUC) range between0.68and 0.78). The study conducted in the U.S. reported a higher sensitivity of their risk score for Hispanics than whites. The limited number of studies, small size and heterogeneity of the combined cohorts provide limited evidence of the validity of risk scores for Hispanics. CONCLUSIONS Efforts to develop and validate risk prediction models in Hispanic populations in the U.S are needed, particularly given the diversity of thisfast growing population. Healthcare professionals should be aware of the limitations of applying risk scores developed for the general population on Hispanics.
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Affiliation(s)
- Lucia D Juarez
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
| | - Jeffrey S Gonzalez
- Graduate School of Psychology, Yeshiva University, USA; Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, USA
| | - April A Agne
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Andrzej Kulczycki
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, USA
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA
| | - John P Shelley
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
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Félix-Martínez GJ, Godínez-Fernández JR. Screening models for undiagnosed diabetes in Mexican adults using clinical and self-reported information. ACTA ACUST UNITED AC 2018; 65:603-610. [PMID: 29945768 DOI: 10.1016/j.endinu.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prevalence of diabetes in Mexico has constantly increased since 1993. Since type 2 diabetes may remain undiagnosed for many years, identification of subjects at high risk of diabetes is very important to reduce its impact and to prevent its associated complications. OBJECTIVE To develop easily implementable screening models to identify subjects with undiagnosed diabetes based on the characteristics of Mexican adults. SUBJECTS AND METHODS Screening models were developed using datasets from the 2006 and 2012 National Health and Nutrition Surveys (NHNS). Variables used to develop the multivariate logistic regression models were selected using a backward stepwise procedure. Final models were validated using data from the 2000 National Health Survey (NHS). RESULTS The model based on the 2006 NHNS included age, waist circumference, and systolic blood pressure as explanatory variables, while the model based on the 2012 NHNS included age, waist circumference, height, and family history of diabetes. The sensitivity and specificity values obtained from the external validation procedure were 0.74 and 0.62 (2006 NHNS model) and 0.76 and 0.55 (2012 NHNS model) respectively. CONCLUSIONS Both models were equally capable of identifying subjects with undiagnosed diabetes (∼75%), and performed satisfactorily when compared to other models developed for other regions or countries.
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Affiliation(s)
- Gerardo J Félix-Martínez
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Iztapalapa, Ciudad de México, Mexico; Department of Applied Mathematics and Computer Sciences, Universidad de Cantabria, Santander, Cantabria, Spain.
| | - J Rafael Godínez-Fernández
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Iztapalapa, Ciudad de México, Mexico
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Scanlan AB, Maia CM, Perez A, Homko CJ, O’Brien MJ. Diabetes Risk Assessment in Latinas: Effectiveness of a Brief Diabetes Risk Questionnaire for Detecting Prediabetes in a Community-Based Sample. Diabetes Spectr 2018; 31:31-36. [PMID: 29456424 PMCID: PMC5813318 DOI: 10.2337/ds16-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Numerous validated questionnaires use self-reported data to quantify individuals' risk of having diabetes or developing it in the future. Evaluations of these tools have primarily used nationally representative data, limiting their application in clinical and community settings. This analysis tested the effectiveness of the American Diabetes Association (ADA) risk questionnaire for identifying prediabetes in a community-based sample of Latinas. METHODS Data were collected using the ADA risk questionnaire and assessing A1C. Among 204 participants without diabetes, we examined the association between individual characteristics and glycemic status. We then calculated the performance characteristics (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the ADA risk questionnaire for detecting prediabetes, using A1C results as the gold standard to define the outcome. RESULTS All participants were women of self-reported Hispanic/Latino ethnicity. Their mean ADA risk score was 5.6 ± 1.6. Latinas who had prediabetes were older, with significantly higher rates of hypertension and a higher ADA risk score than those without prediabetes. At a risk score ≥5-the threshold for high risk set by the ADA-the questionnaire had the following test performance characteristics: sensitivity 77.8%, specificity 41.7%, PPV 76.2%, and NPV 43.9%. CONCLUSION The ADA risk questionnaire demonstrates reasonable performance for identifying prediabetes in a community-based sample of Latinas. Our data may guide other groups' use of this tool in the same target population. Future research should examine the effectiveness of this questionnaire for recruiting diverse populations into diabetes prevention programs. In addition, unique diabetes risk assessment tools for specific target populations are needed and may outperform questionnaires developed using nationally representative data.
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Affiliation(s)
- Adam B. Scanlan
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| | - Catarina M. Maia
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| | - Alberly Perez
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| | - Carol J. Homko
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| | - Matthew J. O’Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kulkarni M, Foraker RE, McNeill AM, Girman C, Golden SH, Rosamond WD, Duncan B, Schmidt MI, Tuomilehto J. Evaluation of the modified FINDRISC to identify individuals at high risk for diabetes among middle-aged white and black ARIC study participants. Diabetes Obes Metab 2017; 19:1260-1266. [PMID: 28321981 PMCID: PMC5568921 DOI: 10.1111/dom.12949] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate a modified Finnish Diabetes Risk Score (FINDRISC) for predicting the risk of incident diabetes among white and black middle-aged participants from the Atherosclerosis Risk in Communities (ARIC) study. RESEARCH DESIGN AND METHODS We assessed 9754 ARIC cohort participants who were free of diabetes at baseline. Logistic regression and receiver operator characteristic (ROC) curves were used to evaluate a modified FINDRISC for predicting incident diabetes after 9 years of follow-up, overall and by race/gender group. The modified FINDRISC used comprised age, body mass index, waist circumference, blood pressure medication and family history. RESULTS The mean FINDRISC (range, 2 [lowest risk] to 17 [highest risk]) for black women was higher (9.9 ± 3.6) than that for black men (7.6 ± 3.9), white women (8.0 ± 3.6) and white men (7.6 ± 3.5). The incidence of diabetes increased generally across deciles of FINDRISC for all 4 race/gender groups. ROC curve statistics for the FINDRISC showed the highest area under the curve for white women (0.77) and the lowest for black men (0.70). CONCLUSIONS We used a modified FINDRISC to predict the 9-year risk of incident diabetes in a biracial US population. The modified risk score can be useful for early screening of incident diabetes in biracial populations, which may be helpful for early interventions to delay or prevent diabetes.
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Affiliation(s)
- Manjusha Kulkarni
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Randi E Foraker
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Ann M McNeill
- Merck Sharp & Dohme Corp., Whitehouse Station, New Jersey
| | - Cynthia Girman
- CERobs Consulting, LLC, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, UNC, Chapel Hill, North Carolina
| | - Sherita H Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bruce Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Maria Ines Schmidt
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Dasman Diabetes Institute, Safat, Kuwait
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Olivera AR, Roesler V, Iochpe C, Schmidt MI, Vigo Á, Barreto SM, Duncan BB. Comparison of machine-learning algorithms to build a predictive model for detecting undiagnosed diabetes - ELSA-Brasil: accuracy study. SAO PAULO MED J 2017; 135:234-246. [PMID: 28746659 PMCID: PMC10019841 DOI: 10.1590/1516-3180.2016.0309010217] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/01/2017] [Indexed: 01/23/2023] Open
Abstract
CONTEXT AND OBJECTIVE: Type 2 diabetes is a chronic disease associated with a wide range of serious health complications that have a major impact on overall health. The aims here were to develop and validate predictive models for detecting undiagnosed diabetes using data from the Longitudinal Study of Adult Health (ELSA-Brasil) and to compare the performance of different machine-learning algorithms in this task. DESIGN AND SETTING: Comparison of machine-learning algorithms to develop predictive models using data from ELSA-Brasil. METHODS: After selecting a subset of 27 candidate variables from the literature, models were built and validated in four sequential steps: (i) parameter tuning with tenfold cross-validation, repeated three times; (ii) automatic variable selection using forward selection, a wrapper strategy with four different machine-learning algorithms and tenfold cross-validation (repeated three times), to evaluate each subset of variables; (iii) error estimation of model parameters with tenfold cross-validation, repeated ten times; and (iv) generalization testing on an independent dataset. The models were created with the following machine-learning algorithms: logistic regression, artificial neural network, naïve Bayes, K-nearest neighbor and random forest. RESULTS: The best models were created using artificial neural networks and logistic regression. -These achieved mean areas under the curve of, respectively, 75.24% and 74.98% in the error estimation step and 74.17% and 74.41% in the generalization testing step. CONCLUSION: Most of the predictive models produced similar results, and demonstrated the feasibility of identifying individuals with highest probability of having undiagnosed diabetes, through easily-obtained clinical data.
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Affiliation(s)
- André Rodrigues Olivera
- MSc. IT Analyst, Postgraduate Computing Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Valter Roesler
- PhD. Professor, Postgraduate Computing Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Cirano Iochpe
- PhD. Professor, Postgraduate Computing Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Maria Inês Schmidt
- PhD. Professor, Postgraduate Epidemiology Program and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Álvaro Vigo
- PhD. Professor, Postgraduate Epidemiology Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Sandhi Maria Barreto
- PhD. Professor, Department of Social and Preventive Medicine & Postgraduate Program in Public Health, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Bruce Bartholow Duncan
- PhD. Professor, Postgraduate Epidemiology Program and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
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Alva ML, Hoerger TJ, Zhang P, Gregg EW. Identifying risk for type 2 diabetes in different age cohorts: does one size fit all? BMJ Open Diabetes Res Care 2017; 5:e000447. [PMID: 29118992 PMCID: PMC5663261 DOI: 10.1136/bmjdrc-2017-000447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/18/2017] [Accepted: 09/03/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate age-specific risk equations for type 2 diabetes onset in young, middle-aged, and older US adults, and to compare the performance of simple equations based on readily available demographic information alone, against enhanced equations that require both demographic and clinical information (fasting plasma glucose, high-density lipoprotein, and triglyceride levels). RESEARCH DESIGN AND METHODS We estimated the probability of developing diabetes by age group using data from the Coronary Artery Risk Development in Young Adults (for ages 18-40 years), Atherosclerosis Risk in Communities (for ages 45-64 years), and the Cardiovascular Health Study (for ages 65 years and older). Simple and enhanced equations were estimated using logistic regression models, and performance was compared by age group. Thresholds based on these risk equations were evaluated using split-sample bootstraps and calibrating the constant of one age cohort to others. RESULTS Simple risk equations had an area under the receiver-operating curve (AUROC) of 0.72, 0.79, 0.75, and 0.69 for age groups 18-30, 28-40, 45-64, and 65 and older, respectively. The corresponding AUROCs for enhanced equations were 0.75, 0.85, 0.85, and 0.81. Risk equations based on younger populations, when applied to older cohorts, underpredict diabetes incidence and risk. Conversely, risk equations based on older populations overpredict the likelihood of diabetes in younger cohorts. CONCLUSIONS In general, risk equations are more successful in middle-aged adults than in young and old populations. The results demonstrate the importance of applying age-specific risk equations to identify target populations for intervention. While the predictive capacity of equations that include biomarkers is better than of those based solely on self-reported variables, biomarkers are more important in older populations than in younger ones.
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Affiliation(s)
- Maria L Alva
- D Phil Public Health Economics Program, RTI International, Washington, DC, USA
| | - Thomas J Hoerger
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Ping Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward W Gregg
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tuomilehto J, Schwarz PEH. Preventing Diabetes: Early Versus Late Preventive Interventions. Diabetes Care 2016; 39 Suppl 2:S115-20. [PMID: 27440823 DOI: 10.2337/dcs15-3000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are a number of arguments in support of early measures for the prevention of type 2 diabetes (T2D), as well as for concepts and strategies at later intervention stages. Diabetes prevention is achievable when implemented in a sustainable manner. Sustainability within a T2D prevention program is more important than the actual point in time or disease process at which prevention activities may start. The quality of intervention, as well as its intensity, should vary with the degree of the identified T2D risk. Nevertheless, preventive interventions should start as early as possible in order to allow a wide variety of relatively low- and moderate-intensity programs. The later the disease risk is identified, the more intensive the intervention should be. Public health interventions for diabetes prevention represent an optimal model for early intervention. Late interventions will be targeted at people who already have significant pathophysiological derangements that can be considered steps leading to the development of T2D. These derangements may be difficult to reverse, but the worsening of dysglycemia may be halted, and thus the clinical onset of T2D can be delayed.
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Affiliation(s)
- Jaakko Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland Center for Vascular Prevention, Danube University Krems, Krems, Austria Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany German Center for Diabetes Research, Paul Langerhans Institute Dresden, Dresden, Germany
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Salinero-Fort MA, Burgos-Lunar C, Lahoz C, Mostaza JM, Abánades-Herranz JC, Laguna-Cuesta F, Estirado-de Cabo E, García-Iglesias F, González-Alegre T, Fernández-Puntero B, Montesano-Sánchez L, Vicent-López D, Cornejo-del Río V, Fernández-García PJ, Sánchez-Arroyo V, Sabín-Rodríguez C, López-López S, Patrón-Barandio P, Gómez-Campelo P. Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study. PLoS One 2016; 11:e0158489. [PMID: 27441722 PMCID: PMC4956208 DOI: 10.1371/journal.pone.0158489] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/16/2016] [Indexed: 01/14/2023] Open
Abstract
Aim To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. Methods A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45–74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. Results The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69–0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72–0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. Conclusions FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.
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Affiliation(s)
- M. A. Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad de Madrid, Madrid, Spain
- MADIABETES Research Group. Madrid, Spain
- Aging and Fragility in the Elderly Group- IdiPAZ, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- * E-mail:
| | - C. Burgos-Lunar
- MADIABETES Research Group. Madrid, Spain
- Aging and Fragility in the Elderly Group- IdiPAZ, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
| | - C. Lahoz
- Servicio de Medicina Interna, Hospital Carlos III, Madrid, Spain
| | - J. M. Mostaza
- Servicio de Medicina Interna, Hospital Carlos III, Madrid, Spain
| | - J. C. Abánades-Herranz
- MADIABETES Research Group. Madrid, Spain
- Aging and Fragility in the Elderly Group- IdiPAZ, Madrid, Spain
- Centro de Salud Monóvar, Servicio Madrileño de Salud, Madrid, Spain
| | - F. Laguna-Cuesta
- Servicio de Medicina Interna, Hospital Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - P. Gómez-Campelo
- MADIABETES Research Group. Madrid, Spain
- Aging and Fragility in the Elderly Group- IdiPAZ, Madrid, Spain
- Plataforma de Apoyo al Investigador Novel (PAIN Platform), Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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Kong APS, Luk AOY, Chan JCN. Detecting people at high risk of type 2 diabetes- How do we find them and who should be treated? Best Pract Res Clin Endocrinol Metab 2016; 30:345-55. [PMID: 27432070 DOI: 10.1016/j.beem.2016.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic disease characterized by its silent and progressive nature. The prevalence of type 2 diabetes (T2DM) increases with age but with a worrying trend of increasingly young age of diagnosis. Compared to their counterparts with late onset of disease, these younger subjects face long disease duration with increased risk of diabetes-related complications. Besides, there is marked phenotypic heterogeneity which can interact with different interventions to give rise to variable clinical outcomes. Recognized at-risk groups include those with known atherosclerosis and vascular disease, genetic background (family history and non-White ethnic groups), phenotypes of insulin resistance (obesity, metabolic syndrome, women with gestational diabetes or polycystic ovarian syndrome, and men with androgen deficiency) and "pre-diabetes" (impaired glucose tolerance and impaired fasting glucose). These risk factors interact to amplify the risk for diabetes, thus emphasizing the importance of comprehensive assessment. Raising awareness and health literacy, regular screening of high risk subjects, structured lifestyle modification program including early use of pharmacological agents, targeting at predominant pathophysiological defects offers a personalized approach to prevent this global hazard.
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Affiliation(s)
- Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
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Wong CKH, Siu SC, Wan EYF, Jiao FF, Yu EYT, Fung CSC, Wong KW, Leung AYM, Lam CLK. Simple non-laboratory- and laboratory-based risk assessment algorithms and nomogram for detecting undiagnosed diabetes mellitus. J Diabetes 2016; 8:414-21. [PMID: 25952330 DOI: 10.1111/1753-0407.12310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the present study was to develop a simple nomogram that can be used to predict the risk of diabetes mellitus (DM) in the asymptomatic non-diabetic subjects based on non-laboratory- and laboratory-based risk algorithms. METHODS Anthropometric data, plasma fasting glucose, full lipid profile, exercise habits, and family history of DM were collected from Chinese non-diabetic subjects aged 18-70 years. Logistic regression analysis was performed on a random sample of 2518 subjects to construct non-laboratory- and laboratory-based risk assessment algorithms for detection of undiagnosed DM; both algorithms were validated on data of the remaining sample (n = 839). The Hosmer-Lemeshow test and area under the receiver operating characteristic (ROC) curve (AUC) were used to assess the calibration and discrimination of the DM risk algorithms. RESULTS Of 3357 subjects recruited, 271 (8.1%) had undiagnosed DM defined by fasting glucose ≥7.0 mmol/L or 2-h post-load plasma glucose ≥11.1 mmol/L after an oral glucose tolerance test. The non-laboratory-based risk algorithm, with scores ranging from 0 to 33, included age, body mass index, family history of DM, regular exercise, and uncontrolled blood pressure; the laboratory-based risk algorithm, with scores ranging from 0 to 37, added triglyceride level to the risk factors. Both algorithms demonstrated acceptable calibration (Hosmer-Lemeshow test: P = 0.229 and P = 0.483) and discrimination (AUC 0.709 and 0.711) for detection of undiagnosed DM. CONCLUSION A simple-to-use nomogram for detecting undiagnosed DM has been developed using validated non-laboratory-based and laboratory-based risk algorithms.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Shing-Chung Siu
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Fang-Fang Jiao
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Esther Y T Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Colman S C Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Ka-Wai Wong
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong
| | | | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Väätäinen S, Cederberg H, Roine R, Keinänen-Kiukaanniemi S, Saramies J, Uusitalo H, Tuomilehto J, Martikainen J. Does Future Diabetes Risk Impair Current Quality of Life? A Cross-Sectional Study of Health-Related Quality of Life in Relation to the Finnish Diabetes Risk Score (FINDRISC). PLoS One 2016; 11:e0147898. [PMID: 26840374 PMCID: PMC4740430 DOI: 10.1371/journal.pone.0147898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 01/11/2016] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Present study examines the relationship between the estimated risk of developing type 2 diabetes (T2D) and health-related quality of life (HRQoL). We quantify the association between Finnish Diabetes Risk Score (FINDRISC) and HRQoL, and examine the potential use of FINDRISC as tool to evaluate HRQoL indirectly. METHODS We conducted a cross-sectional study comprising 707 Finnish people without a diagnosis of T2D between the ages of 51 and 75 years. The risk of developing T2D was assessed using the validated and widely used FINDRISC (range 0-26 points), and quality of life was measured using two preference-based HRQoL instruments (15D and SF-6D) and one health profile instrument (SF-36). Effects of the individual FINDRISC items and demographic and clinical characteristics, such as co-morbidities, on HRQoL were studied using multivariable Tobit regression models. RESULTS Low HRQoL was significantly and directly associated with the estimated risk of developing T2D. An approximate 4-5 point change in FINDRISC score was observed to be associated with clinically noticeable changes in the preference-based instrument HRQoL index scores. The association between HRQoL and the risk of developing T2D was also observed for most dimensions of HRQoL in all applied HRQoL instruments. Overall, old age, lack of physical activity, obesity, and history of high blood glucose were the FINDRISC factors most prominently associated with lower HRQoL. CONCLUSIONS The findings may help the health care professionals to substantiate the possible improvement in glucose metabolism and HRQoL potentially achieved by lifestyle changes, and better convince people at high risk of T2D to take action towards healthier lifestyle habits. FINDRISC may also provide an accurate proxy for HRQoL, and thus by estimating the risk of T2D with the FINDRISC, information about patients' HRQoL may also be obtained indirectly, when it is not feasible to use HRQoL instruments.
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Affiliation(s)
- Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Henna Cederberg
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Risto Roine
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health research, University of Oulu, Oulu, Finland
- Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | | | - Hannu Uusitalo
- Department of Ophthalmology, SILK, School of Medicine, University of Tampere and TAUH Eye Center, Tampere Finland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Dasman Diabetes Institute, Dasman, Kuwait
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Masconi KL, Matsha TE, Erasmus RT, Kengne AP. Effects of Different Missing Data Imputation Techniques on the Performance of Undiagnosed Diabetes Risk Prediction Models in a Mixed-Ancestry Population of South Africa. PLoS One 2015; 10:e0139210. [PMID: 26406594 PMCID: PMC4583496 DOI: 10.1371/journal.pone.0139210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 09/10/2015] [Indexed: 01/30/2023] Open
Abstract
Background Imputation techniques used to handle missing data are based on the principle of replacement. It is widely advocated that multiple imputation is superior to other imputation methods, however studies have suggested that simple methods for filling missing data can be just as accurate as complex methods. The objective of this study was to implement a number of simple and more complex imputation methods, and assess the effect of these techniques on the performance of undiagnosed diabetes risk prediction models during external validation. Methods Data from the Cape Town Bellville-South cohort served as the basis for this study. Imputation methods and models were identified via recent systematic reviews. Models’ discrimination was assessed and compared using C-statistic and non-parametric methods, before and after recalibration through simple intercept adjustment. Results The study sample consisted of 1256 individuals, of whom 173 were excluded due to previously diagnosed diabetes. Of the final 1083 individuals, 329 (30.4%) had missing data. Family history had the highest proportion of missing data (25%). Imputation of the outcome, undiagnosed diabetes, was highest in stochastic regression imputation (163 individuals). Overall, deletion resulted in the lowest model performances while simple imputation yielded the highest C-statistic for the Cambridge Diabetes Risk model, Kuwaiti Risk model, Omani Diabetes Risk model and Rotterdam Predictive model. Multiple imputation only yielded the highest C-statistic for the Rotterdam Predictive model, which were matched by simpler imputation methods. Conclusions Deletion was confirmed as a poor technique for handling missing data. However, despite the emphasized disadvantages of simpler imputation methods, this study showed that implementing these methods results in similar predictive utility for undiagnosed diabetes when compared to multiple imputation.
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Affiliation(s)
- Katya L. Masconi
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tandi E. Matsha
- Department of Biomedical Technology, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T. Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Salinero-Fort MÁ, de Burgos-Lunar C, Mostaza Prieto J, Lahoz Rallo C, Abánades-Herranz JC, Gómez-Campelo P, Laguna Cuesta F, Estirado De Cabo E, García Iglesias F, González Alegre T, Fernández Puntero B, Montesano Sánchez L, Vicent López D, Cornejo Del Río V, Fernández García PJ, Sabín Rodríguez C, López López S, Patrón Barandío P. Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol. BMJ Open 2015; 5:e007195. [PMID: 26220868 PMCID: PMC4521512 DOI: 10.1136/bmjopen-2014-007195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74 years. ANALYSIS sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.
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Affiliation(s)
- Miguel Ángel Salinero-Fort
- Gerencia Adjunta de Planificación y Calidad, Atención Primaria. Servicio Madrileño de Salud, Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ. Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
| | - Carmen de Burgos-Lunar
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ. Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
| | | | | | - Juan Carlos Abánades-Herranz
- Dirección Técnica de Docencia e Investigación. Gerencia Adjunta de Planificación y Calidad. Atención Primaria, Servicio Madrileño de Salud. Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Paloma Gómez-Campelo
- Plataforma de apoyo al Investigador Novel. Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
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Masconi KL, Echouffo-Tcheugui JB, Matsha TE, Erasmus RT, Kengne AP. Predictive modeling for incident and prevalent diabetes risk evaluation. Expert Rev Endocrinol Metab 2015; 10:277-284. [PMID: 30298773 DOI: 10.1586/17446651.2015.1015989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With half of individuals with diabetes undiagnosed worldwide and a projected 55% increase of the population with diabetes by 2035, the identification of undiagnosed and high-risk individuals is imperative. Multivariable diabetes risk prediction models have gained popularity during the past two decades. These have been shown to predict incident or prevalent diabetes through a simple and affordable risk scoring system accurately. Their development requires cohort or cross-sectional type studies with a variable combination, number and definition of included risk factors, with their performance chiefly measured by discrimination and calibration. Models can be used in clinical and public health settings. However, the impact of their use on outcomes in real-world settings needs to be evaluated before widespread implementation.
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Affiliation(s)
- Katya L Masconi
- a 1 Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
- b 2 Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Justin Basile Echouffo-Tcheugui
- c 3 Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- d 4 Department of Medicine, MedStar Health System, Baltimore, MD, USA
| | - Tandi E Matsha
- e 5 Department of Biomedical Technology, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T Erasmus
- a 1 Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre Pascal Kengne
- b 2 Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- f 6 Department of Medicine, University of Cape Town, Cape Town, South Africa
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Habibi S, Ahmadi M, Alizadeh S. Type 2 Diabetes Mellitus Screening and Risk Factors Using Decision Tree: Results of Data Mining. Glob J Health Sci 2015; 7:304-10. [PMID: 26156928 PMCID: PMC4803907 DOI: 10.5539/gjhs.v7n5p304] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/06/2015] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to examine a predictive model using features related to the diabetes type 2 risk factors. Methods: The data were obtained from a database in a diabetes control system in Tabriz, Iran. The data included all people referred for diabetes screening between 2009 and 2011. The features considered as “Inputs” were: age, sex, systolic and diastolic blood pressure, family history of diabetes, and body mass index (BMI). Moreover, we used diagnosis as “Class”. We applied the “Decision Tree” technique and “J48” algorithm in the WEKA (3.6.10 version) software to develop the model. Results: After data preprocessing and preparation, we used 22,398 records for data mining. The model precision to identify patients was 0.717. The age factor was placed in the root node of the tree as a result of higher information gain. The ROC curve indicates the model function in identification of patients and those individuals who are healthy. The curve indicates high capability of the model, especially in identification of the healthy persons. Conclusions: We developed a model using the decision tree for screening T2DM which did not require laboratory tests for T2DM diagnosis.
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Affiliation(s)
| | - Maryam Ahmadi
- Department of Health Information Management, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences.
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Masconi KL, Matsha TE, Echouffo-Tcheugui JB, Erasmus RT, Kengne AP. Reporting and handling of missing data in predictive research for prevalent undiagnosed type 2 diabetes mellitus: a systematic review. EPMA J 2015; 6:7. [PMID: 25829972 PMCID: PMC4380106 DOI: 10.1186/s13167-015-0028-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/07/2015] [Indexed: 01/10/2023]
Abstract
Missing values are common in health research and omitting participants with missing data often leads to loss of statistical power, biased estimates and, consequently, inaccurate inferences. We critically reviewed the challenges posed by missing data in medical research and approaches to address them. To achieve this more efficiently, these issues were analyzed and illustrated through a systematic review on the reporting of missing data and imputation methods (prediction of missing values through relationships within and between variables) undertaken in risk prediction studies of undiagnosed diabetes. Prevalent diabetes risk models were selected based on a recent comprehensive systematic review, supplemented by an updated search of English-language studies published between 1997 and 2014. Reporting of missing data has been limited in studies of prevalent diabetes prediction. Of the 48 articles identified, 62.5% (n = 30) did not report any information on missing data or handling techniques. In 21 (43.8%) studies, researchers opted out of imputation, completing case-wise deletion of participants missing any predictor values. Although imputation methods are encouraged to handle missing data and ensure the accuracy of inferences, this has seldom been the case in studies of diabetes risk prediction. Hence, we elaborated on the various types and patterns of missing data, the limitations of case-wise deletion and state-of the-art methods of imputations and their challenges. This review highlights the inexperience or disregard of investigators of the effect of missing data in risk prediction research. Formal guidelines may enhance the reporting and appropriate handling of missing data in scientific journals.
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Affiliation(s)
- Katya L Masconi
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa ; Non-Communicable Diseases Research Unit, South African Medical Research Council, PO Box 19070, , Tygerberg, 7505 Cape Town, South Africa
| | - Tandi E Matsha
- Department of Biomedical Technology, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Justin B Echouffo-Tcheugui
- Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA USA ; Department of Medicine, MedStar Health System, Baltimore, MD USA
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, PO Box 19070, , Tygerberg, 7505 Cape Town, South Africa ; Department of Medicine, University of Cape Town, Cape Town, South Africa
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Goto M, Goto A, Ikeda N, Noda H, Shibuya K, Noda M. Factors associated with untreated diabetes: analysis of data from 20,496 participants in the Japanese National Health and Nutrition Survey. PLoS One 2015; 10:e0118749. [PMID: 25756183 PMCID: PMC4355906 DOI: 10.1371/journal.pone.0118749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/06/2015] [Indexed: 11/18/2022] Open
Abstract
Objective We aimed to examine factors associated with untreated diabetes in a nationally representative sample of the Japanese population. Research Design and Methods We pooled data from the Japanese National Health and Nutrition Survey from 2005 to 2009 (n = 20,496). Individuals aged 20 years and older were included in the analysis. We classified participants as having diabetes if they had HbA1c levels ≥6.5% (≥48 mmol/mol). People with diabetes who self-reported that they were not currently receiving diabetic treatment were considered to be untreated. We conducted a multinomial logistic regression analysis to determine factors associated with untreated diabetes relative to non-diabetic individuals. Results Of 20,496 participants who were included in the analysis, untreated diabetes was present in 748 (3.6%). Among participants with untreated diabetes, 48.3% were previously diagnosed with diabetes, and 46.5% had HbA1c levels ≥7.0% (≥53 mmol/mol). Participants with untreated diabetes were significantly more likely than non-diabetic participants to be male, older, and currently smoking, have lower HDL cholesterol levels and higher BMI, non-HDL cholesterol levels, and systolic blood pressure. Conclusions A substantial proportion of people in Japan with untreated diabetes have poor glycemic control. Targeting relevant factors for untreated diabetes in screening programs may be effective to enhance the treatment and control of diabetes.
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Affiliation(s)
- Maki Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nayu Ikeda
- Center for International Collaboration and Partnership, National Institute of Health and Nutrition, Tokyo, Japan
| | - Hiroyuki Noda
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
- * E-mail:
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Han L, Luo S, Yu J, Pan L, Chen S. Rule Extraction From Support Vector Machines Using Ensemble Learning Approach: An Application for Diagnosis of Diabetes. IEEE J Biomed Health Inform 2015; 19:728-34. [DOI: 10.1109/jbhi.2014.2325615] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Masconi K, Matsha TE, Erasmus RT, Kengne AP. Independent external validation and comparison of prevalent diabetes risk prediction models in a mixed-ancestry population of South Africa. Diabetol Metab Syndr 2015; 7:42. [PMID: 25987905 PMCID: PMC4435909 DOI: 10.1186/s13098-015-0039-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/01/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Guidelines increasingly encourage the use of multivariable risk models to predict the presence of prevalent undiagnosed type 2 diabetes mellitus worldwide. However, no single model can perform well in all settings and available models must be tested before implementation in new populations. We assessed and compared the performance of five prevalent diabetes risk models in mixed-ancestry South Africans. METHODS Data from the Cape Town Bellville-South cohort were used for this study. Models were identified via recent systematic reviews. Discrimination was assessed and compared using C-statistic and non-parametric methods. Calibration was assessed via calibration plots, before and after recalibration through intercept adjustment. RESULTS Seven hundred thirty-seven participants (27 % male), mean age, 52.2 years, were included, among whom 130 (17.6 %) had prevalent undiagnosed diabetes. The highest c-statistic for the five prediction models was recorded with the Kuwaiti model [C-statistic 0.68: 95 % confidence: 0.63-0.73] and the lowest with the Rotterdam model [0. 64 (0.59-0.69)]; with no significant statistical differences when the models were compared with each other (Cambridge, Omani and the simplified Finnish models). Calibration ranged from acceptable to good, however over- and underestimation was prevalent. The Rotterdam and the Finnish models showed significant improvement following intercept adjustment. CONCLUSIONS The wide range of performances of different models in our sample highlights the challenges of selecting an appropriate model for prevalent diabetes risk prediction in different settings.
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Affiliation(s)
- Katya Masconi
- />Division of Chemical Pathology, Stellenbosch University, Cape Town, South Africa
- />Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tandi E. Matsha
- />Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Rajiv T. Erasmus
- />Division of Chemical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Andre P. Kengne
- />Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- />Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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