[Validation of the FINDRISC (FINnish Diabetes RIsk SCore) for prediction of the risk of type 2 diabetes in a population of southern Spain. Pizarra Study]

External validation of three diabetes prediction scores in a Spanish cohort: does adding high risk for depression improve the validation of the FINDRISC score (FINDRISC-MOOD)?

OBJECTIVES

To evaluate the external validity of the FINDRISC, DESIR and ADA risk scores for the prediction of diabetes in a Spanish population aged >45 years and to test the possible improvement of FINDRISC by adding a new variable of high risk of depression when Patient Health Questionnaire-9 (PHQ-9) questionnaire score ≥10 (FINDRISC-MOOD).

DESIGN

Prospective population-based cohort study.

SETTING

10 primary healthcare centres in the north of the city of Madrid (Spain).

PARTICIPANTS

A total of 1242 participants without a history of diabetes and with 2-hour oral glucose tolerance test (OGTT) plasma glucose <200 mg/dL (<11.1 mmol/L) were followed up for 7.3 years (median) using their electronic health records (EHRs) and telephone contact.

PRIMARY AND SECONDARY OUTCOME MEASURES

Diabetes risk scores (FINDRISC, DESIR, ADA), PHQ-9 questionnaire and 2-hour-OGTT were measured at baseline. Incident diabetes was defined as treatment for diabetes, fasting plasma glucose ≥126 mg/dL (≥7.0 mmol/L), new EHR diagnosis or self-reported diagnosis. External validation was performed according to optimal cut-off, sensitivity, specificity and Youden Index. Comparison between diabetes risk scores, including FINDRISC-MOOD (original FINDRISC score plus five points if PHQ-9 ≥10), was measured by area under the receiver operating characteristic curve (AUROC).

RESULTS

During follow-up, 104 (8.4%; 95% CI, 6.8 to 9.9) participants developed diabetes and 185 had a PHQ-9 score ≥10. The AUROC values were 0.70 (95% CI, 0.67 to 0.72) for FINDRISC-MOOD and 0.68 (95% CI, 0.65 to 0.71) for the original FINDRISC. The AUROCs for DESIR and ADA were 0.66 (95% CI, 0.63 to 0.68) and 0.66 (95% CI, 0.63 to 0.69), respectively. There were no significant differences in AUROC between FINDRISC-MOOD and the other scores.

CONCLUSIONS

The results of FINDRISC-MOOD were like those of the other risk scores and do not allow it to be recommended for clinical use.

[Detection of people at risk of having diabetes in the community pharmacy with the Findrisc test 2014-2021]

Aim

To analyze diabetes risk screening using the Findrisc questionnaire, performed in Spanish community pharmacies (CP) since 2014.

Methods

Descriptive cumulative study of the results of campaigns from Global Diabetes Day, in 2014, 2016-2018, 2020 and 2021.

Subjects

Users ≥18 years not diagnosed with diabetes with signed consent.

Variables

Findrisc test score, mean (m) and standard deviation (SD) and subjects at risk intervals, n (%). Demographic (sex, age) and anthropometric variables, body mass index (BMI) (kg/m2), waist circumference (cm), capillary glycaemia (SD) (mg/dL).

Results

A total of 1146 pharmacists took part; 12,402 users. A total of 8799 (70.9%) had BMI ≥25 kg/m2; 7366 (59.4%) were taking anti-hypertensives, 6047 (48.8%) with excessive abdominal circumference. In total, 5962 (48.0%) had a family history of diabetes.Average risk (Findrisc score) was 11.3 (4.6), without any sex differences (P>0.05). The number of subjects with high/very high risk (F≥15) was 3107 (25.0%) without any sex differences (P>0.05). The high/very high risk increased with age, from 282 (15.1%) people aged 45 to 54 up to 1695 (40.1%) people aged >64. A total of 1762 (14.2%) were referred to the doctor. There are no data on the result.Average interview time: 10.3 (5.3) minutes, no differences between sexes (P>0.05).

Conclusions

One quarter of those surveyed had a high/very high risk and one in seven were referred to the doctor.The most prevalent risk factors were BMI, hypertension, abdominal circumference and family history of diabetes.Interprofessional communication should be improved as no result was obtained from referrals to the doctor.

Prevalence of increased risk of type 2 diabetes in general practice: a cross-sectional study in Norway

BACKGROUND

Type 2 diabetes (T2D) is a global public health problem, but the onset can be delayed or prevented with adequate intervention in individuals with increased risk. Therefore, a major challenge in general practice is to identify individuals at risk of diabetes. However, limited knowledge is available about the prevalence of high diabetes risk individuals in a primary care population. In a cohort of consecutive patients in general practice we examined the prevalence of known diabetes and estimated risk of diabetes using The Finnish Diabetes Risk Score (FINDRISC) calculator, by sociodemographic and clinical characteristics.

METHODS

This study was a cross-sectional study conducted in four general practices in Western and Eastern Norway. A total of 1682 individuals, 20-80 years of age, were assessed for eligibility from May to December 2019. We excluded patients who actively declined participation (n = 112), were lost because of various organization challenges (n = 103) and patients who did not fulfil the inclusions criteria (n = 63). Diabetes prevalence and prevalence of individuals at risk of T2D with 95% confidence intervals (CI) were estimated for the total sample, by age group and for men and women separately. We tested for differences between groups using t-test for continuous variables and chi-square test (Pearson Chi-Square) for categorical variables.

RESULTS

Of 1404 individuals, 132 reported known diabetes, yielding a prevalence of 9.9% (95% CI 8.4-11.6). Among participants without a known diagnosis of diabetes, the following estimates of elevated risk assessment scores were found: FINDRISC score ≥ 11 32.8% (95% CI 30.3-35.4) and FINDRISC ≥ 15 10.0% (95% CI 8.6-11.9). Comparable results were found between the sexes.

CONCLUSIONS

Detection of unknown diabetes and individuals with increased risk, is of high public health relevance for early implementation of preventive measures aimed to reduce the risk of diabetes and its complications through lifestyle modification. A simple, non-expensive questionnaire, such as FINDRISC, may be valuable as an initial screening method in general practice to identify those in need for preventive measures.

Large scale application of the Finnish diabetes risk score in Latin American and Caribbean populations: a descriptive study

Background

The prevalence of type 2 diabetes (T2D) continues to increase in the Americas. Identifying people at risk for T2D is critical to the prevention of T2D complications, especially cardiovascular disease. This study gauges the ability to implement large population-based organized screening campaigns in 19 Latin American and Caribbean countries to detect people at risk for T2D using the Finnish Diabetes Risk Score (FINDRISC).

Methods

This cross-sectional descriptive analysis uses data collected in a sample of men and women 18 years of age or older who completed FINDRISC via eHealth during a Guinness World Record attempt campaign between October 25 and November 1, 2021. FINDRISC is a non-invasive screening tool based on age, body mass index, waist circumference, physical activity, daily intake of fruits and vegetables, history of hyperglycemia, history of antihypertensive drug treatment, and family history of T2D, assigning a score ranging from 0 to 26 points. A cut-off point of ≥ 12 points was considered as high risk for T2D.

Results

The final sample size consisted of 29,662 women (63%) and 17,605 men (27%). In total, 35% of subjects were at risk of T2D. The highest frequency rates (FINDRISC ≥ 12) were observed in Chile (39%), Central America (36.4%), and Peru (36.1%). Chile also had the highest proportion of people having a FINDRISC ≥15 points (25%), whereas the lowest was observed in Colombia (11.3%).

Conclusions

FINDRISC can be easily implemented via eHealth technology over social networks in Latin American and Caribbean populations to detect people with high risk for T2D. Primary healthcare strategies are needed to perform T2D organized screening to deliver early, accessible, culturally sensitive, and sustainable interventions to prevent sequelae of T2D, and reduce the clinical and economic burden of cardiometabolic-based chronic disease.

[Pilot trial on the detection of patients with undiagnosed diabetes mellitus type 2 performed in community pharmacies in Valladolid. Environmental impact evaluation]

Introduction

The complications that DM2 can develop, and the undiagnosed population (6%) highlight the importance of screening at the population level. The aim of this work is to evaluate and verify whether the professional activity performed in pharmacies is a good point to detect patients with undiagnosed type 2 diabetes mellitus and to refer them for a possible diagnosis. Moreover, to evaluate the environmental impact of the actions.

Methodology

Findrisc questionnaire for patients who met the inclusion criteria and agreed to participate in the study. Basal capillary blood glucose measurement if the result was ≥15 points and referral to a physician if blood glucose was ≥110mg/dL.

Results

44 pharmacies participated. The sample included 434 users; those with high or very high risk (Findrisc ≥15) underwent capillary basal glycemia, with a mean result of 124.51 mg/dL (SD=33.6). Out of the 89 patients referred to the physician (20.5%), the patients diagnosed with diabetes type 2 accounted for 3% of the analyzed sample.

Conclusions

The number of newly diagnosed patients (3%) reflects that the community pharmacy is a good place for diabetes detection. In addition, the study reveals pharmacists' usefulness in their role as a health educator, since they provide guidance on healthy lifestyle habits to those patients not subject to physician referral. Furthermore, closer collaborations between physicians and pharmacists would be necessary in diabetes screening, since the return of information was low; although we can observe that in rural areas, where the relationship is close, the return rate was 85.2%.

Riesgo cardiovascular en pacientes con FINDRISC-C mayor o igual a 12

Introducción: la herramienta FINDRISC permite calcular el riesgo de desarrollar diabetes con punto de corte para Colombia de 12.  Existe evidencia de que el riesgo cardiovascular se incrementa a medida que lo hace el puntaje, pero en Colombia no existe información cuando es ≥ 12. Objetivo: establecer el riesgo cardiovascular (RCV) en pacientes con FINDRISK-C ≥ 12 mediante score Framingham ajustado para Colombia.  Materiales y métodos: subanálisis transversal retrospectivo en 796 pacientes a quienes se les aplicó el cuestionario FINDRISC-C, de ellos 293 con puntaje ≥ 12 y 262 cumplieron los criterios de elegibilidad. Antes se les calculó el RCV mediante análisis uni y multivariado, significancias estadísticas y análisis de correspondencias múltiple. Resultados: 262 pacientes, 63% mujeres, 87% tuvieron sobrepeso y obesidad, promedio de perímetro abdominal 97 cm, 10% eran fumadores y 48% tenían antecedente familiar de diabetes mellitus tipo 2. Se encontró una media de RCV de 8,10 (IC 7,29-8,91), al estratificar por FINDRISC-C la media para cada una de las categorías fue: FINDRISC-C moderado 7,83; FINDRISC-C alto 7,87, FINDRISC-C muy alto 12,61.  La prevalencia de dislipidemia fue de 46,2 % (IC 95%: 40-50) siendo mayor en hombres (53,6%). Conclusión: los pacientes con FINDRISC-C ≥ 12 tienen un RCV entre moderado y alto, existiendo tendencia al incremento del porcentaje de riesgo calculado según score Framingham ajustado para Colombia, a medida que aumenta el puntaje FINDRISC-C.  La prevalencia de dislipidemia en pacientes con FINDRISC-C ≥ 12 fue elevada.

Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18-69 years

BACKGROUND

The application of risk scores has often effectively predicted undiagnosed type 2 diabetes in a non-invasive way to guide early clinical management. The capacity for diagnosing diabetes in developing countries including Kenya is limited. Screening tools to identify those at risk and thus target the use of limited resources could be helpful, but these are not validated for use in these settings. We, therefore, aimed to measure the performance of the Finnish diabetes risk score (FINDRISC) as a screening tool to detect undiagnosed diabetes among Kenyan adults.

METHODS

A nationwide cross-sectional survey on non-communicable disease risk factors was conducted among Kenyan adults between April and June 2015. Diabetes mellitus was defined as fasting capillary whole blood ≥ 7.0mmol/l. The performance of the original, modified, and simplified FINDRISC tools in predicting undiagnosed diabetes was assessed using the area under the receiver operating curve (AU-ROC). Non-parametric analyses of the AU-ROC, Sensitivity (Se), and Specificity (Sp) of FINDRISC tools were determined.

RESULTS

A total of 4,027 data observations of individuals aged 18-69 years were analyzed. The proportion/prevalence of undiagnosed diabetes and prediabetes was 1.8% [1.3-2.6], and 2.6% [1.9-3.4] respectively. The AU-ROC of the modified FINDRISC and simplified FINDRISC in detecting undiagnosed diabetes were 0.7481 and 0.7486 respectively, with no statistically significant difference (p = 0.912). With an optimal cut-off ≥ 7, the simplified FINDRISC had a higher positive predictive value (PPV) (7.9%) and diagnostic odds (OR:6.65, 95%CI: 4.43-9.96) of detecting undiagnosed diabetes than the modified FINDRISC.

CONCLUSION

The simple, non-invasive modified, and simplified FINDRISC tools performed well in detecting undiagnosed diabetes and may be useful in the Kenyan population and other similar population settings. For resource-constrained settings like the Kenyan settings, the simplified FINDRISC is preferred.

Evaluation under real-life conditions of a lifestyle intervention for diabetes prevention developed by the municipal health services of Madrid, Spain

The Diet, Physical Activity and Health (Alimentación, Actividad física y Salud, ALAS) program is an intervention implemented by the municipal health services of Madrid with the objective of reducing weight and preventing diabetes in high-risk population by improving diet and physical activity. The ALAS program combines individual visits with a 10-session group workshop that takes place over a 6-month period. This study evaluated the effectiveness of the ALAS intervention implemented under real-life conditions between 2016 and 2019. The intervention was evaluated with a pre- and post-intervention study with follow-up performed 6 and 12 months from the start of the program. The analyzed outcomes were a 5-10% reduction in the initial weight, body mass index (BMI), waist circumference and a change in glycemic status in prediabetic participants. Statistical models were adjusted by sociodemographic variables. The participants were recruited from municipal community health centers or referred by municipal occupational health services. Between 2016 and 2019, 1629 people participated in the program. At 6 months, 85% of the participants had lost weight; 43% had lost 5% or more of their initial weight, and 12% had lost 10% or more. Regarding BMI, 22.3% of participants who were initially obese were no longer obese, and 15.2% of the overweight participants achieved normal weight. A total of 35.1% of the prediabetic participants reverted to normoglycemic status. The intervention was found to be more effective for men, for those who completed the intervention and those who accessed the program through the occupational health route. Among the participants who accessed the intervention via the community, the intervention was more effective in those with a high educational level. The evaluation demonstrated the effectiveness of the ALAS program for reducing weight and the risk of developing Type 2 diabetes when applied under real-life conditions. The effectiveness of the intervention differed according to gender, access route and educational level of the participants.

Efficacy of an Online Educational Intervention in Reducing Body Weight in the Pre-Diabetic Population of 18-45 Years Old, a Randomized Trial Protocol

Aim: to analyze the efficacy of an educational online intervention focused on lifestyle changes in reducing body weight from baseline to 6 months in the pre-diabetic population of 18−45 years old in Extremadura (Spain). Methods: a single-blind, multicenter randomized parallel-comparison trial with two intervention groups in a 1:1 ratio will be carried out. Participants will be randomly assigned to intervention A or B with 37 cases in each group according to inclusion criteria of being enrolled or working at Extremadura University, scoring >7 points on the Findrisc test and not having diagnosed diabetes mellitus or physical disabilities. Intervention-A group will have access to online information about healthy diet and exercise. Intervention-B group will have access to a six-session educational program regarding behavioral changes in diet and exercise habits. They will complete follow-up activities and have a personal trainer and motivation. The primary outcome will be identifying changes in body weight from baseline to 1 and 6 months and between groups. The secondary outcomes will be accomplishing regular physical activity (>30 min/day or >4 h/week), decreasing sugary food intake or avoiding it altogether, increasing vegetable/fruit intake and lowering HbA1c levels to non-diabetic status when necessary.

[Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.

Comparison of the Finnish Diabetes Risk Score Model With the Metabolic Syndrome in a Shanghai Population

AIMS

This study aimed to compare the diagnostic accuracy of the metabolic syndrome with the Finnish Diabetes Risk Score (FINDRISC) to screen for type 2 diabetes mellitus (T2DM) in a Shanghai population.

METHODS

Participants aged 25-64 years were recruited from a Shanghai population from July 2019 to March 2020. Each participant underwent a standard metabolic work-up, including clinical examination with anthropometry. Glucose status was tested using hemoglobin A1c (HbAlc), 2h-post-load glucose (2hPG), and fasting blood glucose (FBG). The FINDRISC questionnaire and the metabolic syndrome were examined. The performance of the FINDRISC was assessed using the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

Of the 713 subjects, 9.1% were diagnosed with prediabetes, whereas 5.2% were diagnosed with T2DM. A total of 172 subjects had the metabolic syndrome. A higher FINDRISC score was positively associated with the prevalence of T2DM and the metabolic syndrome. Multivariable linear regression analysis demonstrated that the FINDRISC had a linear regression relationship with 2hPG levels (b'= 036, p < 0.0001). The AUC-ROC of the FINDRISC to identify subjects with T2DM among the total population was 0.708 (95% CI 0.639-0.776), the sensitivity was 44.6%, and the specificity was 90.1%, with 11 as the cut-off point. After adding FBG or 2hPG to the FINDRISC, the AUC-ROC among the total population significantly increased to 0.785 (95% CI 0.671-0.899) and 0.731 (95% CI 0.619-0.843), respectively, while the AUC-ROC among the female group increased to 0.858 (95% CI 0.753-0.964) and 0.823 (95% CI 0.730-0.916), respectively (p < 0.001). The AUC-ROC of the metabolic syndrome to identify subjects with T2DM among the total and female population was 0.805 (95% CI 0.767-0.844) and 0.830 (95% CI 0.788-0.872), respectively, with seven as the cut-off point.

CONCLUSIONS

The metabolic syndrome performed better than the FINDRISC model. The metabolic syndrome and the FINDRISC with FBG or 2hPG in a two-step screening model are both efficacious clinical practices for predicting T2DM in a Shanghai population.

[Cardiovascular preventive recommendations. PAPPS 2020 update]

The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: Epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; Cardiovascular (CV) risk tables and recommendations for the calculation of CV risk; Main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; Indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation. The quality of testing and the strength of the recommendation are included in the main recommendations.

New Simplified Diagnostic Decision Trees for the Detention of Metabolic Syndrome in the Elderly

BACKGROUND

A new simplified method for the detention of metabolic syndrome (MetS) is proposed using two variables (anthropometric and minimally invasive).

METHODS

A study of MetS prevalence was made on a sample of 361 older people. The anthropometric variables analyzed were: blood pressure, body mass index, waist circumference (WC), waist-height ratio, body fat percentage, and waist-hip ratio. A crude and adjusted binary logistic regression was performed, and receiver operating characteristic curves were obtained for determining the predictive capacity of those variables. For the new detection method, decision trees were employed using automatic detection by interaction through Chi-square.

RESULTS

The prevalence of the MetS was of 43.7%. The final decision trees uses WC and basal glucose (BG), whose cutoff values were: for men, WC ≥ 102.5 cm and BG > 98 mg/dL (sensitivity = 67.1%, specificity = 90.3%, positive predictive value = 85%, validity index = 79.9%); and for women, WC ≥ 92.5 cm and BG ≥ 97 mg/dL (sensitivity = 65.9%, specificity = 92.7%, positive predictive value = 87.1%, validity index = 81.3%). In older women the best predictive value of MetS was a WC of 92.5 cm.

CONCLUSIONS

It is possible to make a simplified diagnosis of MetS in older people using the WC and basal capillary glucose, with a high diagnostic accuracy and whose use could be recommended in the resource-poor health areas. A new cutting point in older women for the WC should be valued.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study

BACKGROUND

The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes.

OBJECTIVE

To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese.

DESIGN AND SETTING

Questionnaire validity study conducted at a private university.

METHODS

The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study.

RESULTS

For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found.

CONCLUSION

The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

The FINDRISC questionnaire capacity to predict diabetes mellitus II, arterial hypertension and comorbidity in women from low-and-middle-income countries

The Finnish Diabetes Risk Score (FINDRISC) has been implemented to assess diabetes risk. The authors aimed in this study to determine the prediction capacity of FINDRISC for the early detection of cardiovascular diseases in women. A prevalence study was carried out on 441 women of Pueblo Libre (Peru). Anthropometric variables, blood pressure, blood glucose and comorbidity were measured and entered in FINDRISC. 4.8% of the studied women suffered from DM2, 14.3% from AHT, 33% obesity and 8.6% comorbidity. We found that FINDRISC was the best method to discriminate DM, AHT and comorbidity. FINDRISC is an effective non-invasive tool for women from low-and-middle-income countries.

Detection of risk for type 2 diabetes and its relationship with metabolic alterations in nurses

Objective:

to detect the risk of development of type 2 diabetes in nurses and its relationship with metabolic alterations.

Method:

cross-sectional study, with 155 nurses. The variables investigated were: sociodemographic, body mass index, waist circumference, waist-hip index, lipid profile, basal glycemia and oral glucose tolerance curve. The Finnish Diabetes Risk Score was used to collect data.

Results:

155 nurses were included, with an average age of 44 years and 85% were overweight or obese. 52% had a family history of diabetes and 21% had occasional hyperglycemia. With respect to the risk, 59% were identified with moderate and very high risk for type 2 diabetes. Glucose, insulin, glycosylated hemoglobin A1c and insulin resistance increased in parallel to the increased risk for type 2 diabetes, although lipids did not increase. 27% of the sample had impaired fasting glycemia. 15% had glucose intolerance and 5% had type 2 diabetes.

Conclusion:

there was a high detection rate of people at risk for type 2 diabetes (59%) and the high and very high risk score was associated with high levels of glycosylated hemoglobin A1c, glucose, insulin and insulin resistance, but not with lipids.

FINDRISC Modified for Latin America as a Screening Tool for Persons with Impaired Glucose Metabolism in Ciudad Bolívar, Venezuela

OBJECTIVE

The Finnish Diabetes Risk Score (FINDRISC) includes anthropometric, metabolic, and lifestyle factors that predict type 2 diabetes mellitus. The objective of this study was to evaluate the FINDRISC modified for Latin America (LA-FINDRISC) as a screening tool for persons with impaired glucose metabolism in Ciudad Bolívar, Venezuela.

METHODS

Subjects aged between 18 and 70 years of both sexes without known diabetes were invited to participate. After informed consent, they were screened with the LA-FINDRISC questionnaire and then given an oral glucose tolerance test, using the American Diabetes Association criteria for diagnosis. To obtain the cutoff point of LA-FINDRISC for predicting impaired glucose regulation, a receiver operating characteristic curve was constructed.

RESULTS

A total of 200 subjects were evaluated, 64.5% female, with a mean age of 35.20 ± 13.84 years. Of these, 158 (79%) did not present with carbohydrate metabolism disorder, while 42 (21%) did. Age (p = 0.0001), body mass index (p = 0.011), and waist circumference (p = 0.031) were significantly higher in subjects with impaired glucose regulation when compared to those without it. There were a significantly greater number of sedentary (p = 0.039) and hypertensive subjects (p = 0.0001), as well as those with a history of glucose >100 mg/dL (p = 0.0001), in the impaired glucose metabolism group. A cutoff LA-FINDRISC of 14 points predicted a high risk of impaired glucose regulation with a sensitivity of 45.2% and a specificity of 89.9%.

CONCLUSION

A LA-FINDRISC >14 points had low sensitivity but high specificity for predicting carbohydrate metabolism disorders in this group of patients from Ciudad Bolívar.

Validation of DIABSCORE in screening for Type 2 Diabetes and prediabetes in Tunisian population

AIMS

To perform a validation of DIABSCORE in a sample of Tunisian adults and find out the optimal cut-off point for screening of Type 2 diabetes (T2D) and prediabetes.

METHODS

225 adults 18-75 years and a subgroup of 138 adults (18-54 years), with undiagnosed T2D from the region of Cap-Bon, Tunisia were included in the present study. The DIABSCORE was calculated based on: age, waist/height ratio, family history of T2D and gestational diabetes. Receiver operating characteristics (ROC) curves and areas under curve (AUC) were obtained. The T2D and prediabetes prevalences odds ratios (OR) between patients exposed and not exposed to DIABSCORE≥90 and DIABSCORE≥80, respectively were calculated in both age ranges.

RESULTS

For screening of T2D the best value was DIABSCORE = 90 with a highest sensitivity (Se), negative predictive value (NPV) and lower negative likelihood ratio in participants aged 18-75 yr (Se = 97%; NPV = 97%) when compared to participants aged 18-54 yr (Se = 95%; NPV = 97%); for prediabetes, the best Se and NPV were for DIABSCORE = 80 in both age groups, but it showed a disbalanced sensitivity-specificity. The ROC curves for T2D showed a similar AUC in both age ranges (AUC = 0.62 and AUC = 0.61 respectively). The ROC curves for prediabetes showed a highest AUC in those aged 18-54 years than the older ones (AUC = 0.62 and AUC = 0.57, respectively). The prevalences OR of T2D for DIABSCORE≥90 was higher than for DIABSCORE≥80 in both age ranges. Nevertheless, the prevalences OR of prediabetes for DIABSCORE≥90 was half of the detected for DIABSCORE≥80 in both age ranges.

CONCLUSION

The DIABSCORE is a simple clinical tool and accurate method in screening for T2D and prediabetes in the adult Tunisian population.

Prevención en diabetes mellitus y riesgo cardiovascular: enfoque médico y nutricional

Introducción. La epidemia de diabetes mellitus tipo 2 (DM2) incrementa la enfermedad cardiovascular y la morbimortalidad; por tanto, es importante prevenir, tratar integralmente y valorar complicaciones y comorbilidades asociadas.Objetivo. Presentar una revisión sobre prevención de DM2 y riesgo cardiovascular con enfoque médico y nutricional.Materiales y métodos. Se hizo una revisión en las bases de datos Embase, PubMed, Bireme (LILACS, SciELO) y Cochrane Library con términos específicos. La búsqueda se hizo en inglés y español sobre publicaciones entre 2001 y 2016.Resultados. Se encontraron 811 publicaciones y, después de aplicar los criterios de inclusión y exclusión, se seleccionaron 71 documentos clasificados así: 24 artículos de investigación, 14 artículos de revisión, 18 guías clínicas, 8 consensos y 7 de otras categorías (informes, capítulos de libro, normatividad y un libro)Conclusión. La educación es una herramienta fundamental para prevenir y tratar factores de riesgo. Se debe incentivar el trabajo en equipo con el paciente y la familia para reducir el desarrollo de comorbilidades asociadas a DM2.

A Mobile App for Identifying Individuals With Undiagnosed Diabetes and Prediabetes and for Promoting Behavior Change: 2-Year Prospective Study

BACKGROUND

To decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease.

OBJECTIVE

The objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users' chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users' lifestyle behavior changes after ascertaining their risk level from the app.

METHODS

We conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users' profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users' lifestyle changes.

RESULTS

A total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t₈₁=-3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t₈₁=-2.08, P=.04).

CONCLUSIONS

The Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle.

Risk assessment and HbA1c measurement in Norwegian community pharmacies to identify people with undiagnosed type 2 diabetes - A feasibility study

OBJECTIVES

Determine the feasibility of using a diabetes risk assessment tool followed by HbA1c-measurement in a community-pharmacy setting in Norway.

METHODS

In this longitudinal study two pharmacists in each of three community pharmacies were trained to perform risk assessments, HbA1c-measurements and counselling. Pharmacy customers who were > 18 years old and could understand and speak Norwegian or English were recruited in the pharmacies during a two-months-period. Information about the service was presented in local newspapers, social media, leaflets and posters at the pharmacy. Customers wishing to participate contacted the pharmacy staff. Participants completed a validated diabetes risk test and a background questionnaire including a validated instrument for self-rated health. A HbA1c measurement was performed for individuals with a moderate to high risk of developing diabetes. If HbA1c ≥ 6.5% they were recommended to visit their general practitioner for follow-up. The pharmacies performed internal and external quality control of the HbA1c instrument.

RESULTS

Of the 211 included participants 97 (46%) were > 50 years old. HbA1c was measured for the 47 participants (22%) with high risk. Thirty-two (15%) had HbA1c values < 5.7%, twelve (5.4%) had values between 5.7%-6.4%, and three (1.4%) had an HbA1c ≥ 6.5%. Two participants with HbA1 ≥ 6.5% were diagnosed with diabetes by their general practitioner. The third was lost to follow-up. Results from internal and external quality control for HbA1c were within set limits.

CONCLUSION

The pharmacists were able to perform the risk assessment and measurement of HbA1c, and pharmacy customers were willing to participate. The HbA1c measurements fulfilled the requirements for analytical quality. Thus, it is feasible to implement this service in community pharmacies in Norway. In a large-scale study the inclusion criteria should be increased to 45 years in accordance with the population the risk test has been validated for.

Evaluating FINDRISC as a screening tool for type 2 diabetes among overweight adults in the PREVIEW:NZ cohort

AIMS

This study aimed to evaluate the efficacy of a high (≥12) Finnish diabetes risk (FINDRISC) score in identifying undiagnosed prediabetes and type 2 diabetes (T2D) in an New Zealand population of overweight and obese individuals, across a variety of ethnic groups.

METHODS

We estimated the efficacy of elevated FINDRISC scores in predicting prediabetes and T2D in 424 overweight adults with no prior diagnosis recruited for the PREVention of diabetes through lifestyle Interventions in Europe and Worldwide (PREVIEW) study. All participants who completed the FINDRISC questionnaire during a pre-screening phase with a score of ≥12 were then screened using a 2h oral glucose tolerance test (2h-OGTT) to identify undiagnosed dysglycaemia.

RESULTS

Of the 424 participants, 65% (n=280) were pre-diabetic and 7% (n=32) had undiagnosed T2D. A higher FINDRISC score was significantly associated with prediabetes and T2D (P=0.02). There was a significant association between ethnicity and glycaemic status (normal vs prediabetes/T2D, P=0.02). Increasing the FINDRISC cut-off to ≥15 resulted in a non-significant increase in the proportion of participants correctly classified with dysglycaemia. ROC-AUC=0.6 with sensitivity=0.6026 (95% CI: 0.5459-0.6573) and specificity=0.5536 (95% CI: 0.4567-0.6476). Isolated impaired fasting glucose (IFG) was more efficient in predicting dysglycaemia than isolated impaired glucose tolerance (IGT).

CONCLUSIONS

The FINDRISC questionnaire is a useful and efficacious screening tool to identify unknown prediabetes and T2D in overweight New Zealanders, particularly in Maori individuals.

Risk of Type 2 Diabetes Mellitus Development in the Native Population of Low- and High-Altitude Regions of Kyrgyzstan: Finnish Diabetes Risc Score Questionnaire Results

Moldobaeva, Marina S., Anastasiya V. Vinogradova, and Marina K. Esenamanova. Risk of type 2 diabetes mellitus development in the native population of low- and high-altitude regions of Kyrgyzstan: Finnish Diabetes Risc Score questionnaire results. High Alt Med Biol. 18:428-435, 2017.

OBJECTIVE

The number of patients with diabetes is steadily growing, but likely only half of all cases are ever identified. The Kyrgyz, native inhabitants of Central Asia, live in the mountainous area and have a particular lifestyle and nutrition. However, the risk of type 2 diabetes mellitus (T2DM) in our population is not well defined. Therefore, we aimed at determining the risk of T2DM development in the Kyrgyz population residing in low- and high-altitude (HAlt) regions by using the Finnish Diabetes Risc Score (FINDRISC) questionnaire.

METHODS

We included in the study 3190 randomly selected participants, including 1780 low-altitude (LAlt) residents (Chu region, 500-1200 m) and 1410 HAlt residents (Naryn region, 2000-4500 m), among whom there were 1207 men and 1983 women. Assessment of T2DM development was conducted by using the FINDRISC questionnaire and risk stratification was performed by region of residency, gender, and age.

RESULTS

An irregular intake of vegetables and fruits, increased waist circumference (WC), and increased body mass index (BMI) were identified as leading risk factors of T2DM development in native residents of Chu and Naryn regions of Kyrgyzstan. The 10-year risk stratification of T2DM development revealed the absence of a very high-risk group; high-risk status was more frequently identified among residents of the LAlt Chu district (4.7% of women and 2.1% of men), as compared with the HAlt population (1.9% of women and 1% of men) (p = 0.0018 for women and p = 0.09 for men).

CONCLUSIONS

In the Kyrgyz population, a 10-year high risk of T2DM development is greater among residents of LAlts as compared with HAlts, irrespective of gender. No very high-risk group was detected in residents of low or HAlts. The leading composites of FINDRISC score are increased WC and BMI, possibly due to irregular intake of vegetables and fruits that are dependent on the altitude of residence and age.

Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care

AIMS

To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients.

METHODS

Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed.

RESULTS

In both regions, the valid cut-off point for diabetes (DIABSCORE=100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7-31.5) in Canarian and 18.3 (8.0-51.1) in Valencian; and for glucose ≥126mg/dL it was, respectively, 123.0 (58.8-259.2) and 303.1 (162.5-583.8). However, glucose ≥126mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126mg/dL (10.8 € and 10.5 €, respectively).

CONCLUSIONS

DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.

Signs of subclinical atherosclerosis in asymptomatic patients at increased risk of type 2 diabetes mellitus

AIMS

We aimed to study carotid intima media thickness (CIMT) in asymptomatic patients with an increased risk of type 2 diabetes mellitus (T2DM) and in a pre-diabetic state.

METHODS

Diabetes risk assessment was performed in 2420 participants in a voluntary screening program between 2011 and 2013. The risk of T2DM was estimated by the Findrisc scoring system (FR). A FR≥12 was considered as increased risk. HbA1c% between 5.7 and 6.4% signified a pre-diabetic state. Carotid duplex scan was performed and CIMT above 0.9 mm was regarded as pathological. Patients with T2DM or a history of cardiovascular disease were excluded.

RESULTS

Overall 1475 subjects were included. Four groups were compared: "control" (normal HbA1c, FR<12), "HbA1c only" (HbA1c: 5.7-6.4%, FR<12), "Findrisc only" (normal HbA1c, FR≥12) and "combined" (HbA1c: 5.7-6.4%, FR≥12). Frequency of pathological maximal CIMT was 9.4%, 19.7%, 27.4% and 36.4% in the groups, respectively (p<0.001). Logistic regression analysis revealed that compared to control subjects, sex and risk factor-adjusted Odds Ratios for the presence of pathological maximal CIMT were 2.2 (p<0.001), 3.4 (p<0.001) and 5.1 (p<0.001) for the groups, respectively.

CONCLUSIONS

Evaluation of Findrisc score and HbA1c at population level may facilitate early recognition of subclinical vascular complications even in the pre-diabetic state.

Detection of people at risk of diabetes in community pharmacies of Pontevedra (Spain) (DEDIPO)

OBJECTIVE

The aim of this study was to detect people at risk of suffering diabetes or changes in carbohydrate metabolism and to refer them for possible diagnosis to health care centres. The number of diagnoses and costs for the pharmacy were recorded.

METHODS

A cross-sectional, observational study was conducted in community pharmacies in Pontevedra in September-October of 2014. The Findrisc questionnaire was completed by pharmacy users over 18 years old. If Findrisc score was ≥ 15, capillary blood glucose was measured, and the participant was referred to a physician if the value was ≥110mg/dL. The main variables included score in the Findrisc questionnaire, number of diabetes diagnosed, and cost of the service. Differences between the groups were calculated using a Chi-squared test, a Student's t test, and/or a Wilcoxon test.

RESULTS

This study was conducted in 180 pharmacies on a sample of 4,222 users, including 992 (23.5%) with a high or very high risk of diabetes (F≥15). In the 1,060 basal capillary blood glucose tests performed, mean glucose level was 110.2 (SD=20.4)mg/dL (56-254). The Galician Health Service sent information about 83 of the 384 (9.1%) subjects referred to a physician: 28 (33.7%) of them were diagnosed with diabetes (3.1% of the sample), and 26 (31.3%) were diagnosed with prediabetes (2.8% of the sample). Cost per diagnosed subject was € 184.22 per subject with diabetes and € 96.86 per subject with prediabetes.

CONCLUSIONS

The proportion of subjects with new diagnosis of diabetes (3.1%) shows the high efficiency of a screening program for hidden diabetics implemented at community pharmacies as the one presented here.

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Background

Prevention of type 2 diabetes mellitus (T2DM) is a global priority; however, there is a lack of evidence investigating how to effectively translate prevention research into a primary care setting.

Objectives

(1) To develop and validate a risk score to identify individuals at high risk of T2DM in the UK; and (2) to establish whether or not a structured education programme targeting lifestyle and behaviour change was clinically effective and cost-effective at preventing progression to T2DM in people with prediabetes mellitus (PDM), identified through a risk score screening programme in primary care.

Design

A targeted screening study followed by a cluster randomised controlled trial (RCT), with randomisation at practice level. Participants were followed up for 3 years.

Setting

A total of 44 general practices across Leicestershire, UK. The intervention took place in the community.

Participants

A total of 17,972 individuals from 44 practices identified through the risk score as being at high risk of T2DM were invited for screening; of these, 3449 (19.2%) individuals attended. All received an oral glucose tolerance test. PDM was detected in 880 (25.5%) of those screened. Those with PDM were included in the trial; of these, 36% were female, the average age was 64 years and 16% were from an ethnic minority group.

Intervention

Practices were randomised to receive either standard care or the intervention. The intervention consisted of a 6-hour group structured education programme, with an annual refresher and regular telephone contact.

Main outcome measures

The primary outcome was progression to T2DM. The main secondary outcomes were changes in glycated haemoglobin concentrations, blood glucose levels, cardiovascular risk, the presence of metabolic syndrome, step count and the cost-effectiveness of the intervention.

Results

A total of 22.6% of the intervention group did not attend the education and 29.1% attended all sessions. A total of 131 participants developed T2DM (standard care,n = 67; intervention,n = 64). There was a 26% reduced risk of T2DM in the intervention arm compared with standard care, but this did not reach statistical significance (hazard ratio 0.74, 95% confidence interval 0.48 to 1.14;p = 0.18). There were statistically significant improvements in glycated haemoglobin concentrations, low-density lipoprotein cholesterol levels, psychosocial well-being, sedentary time and step count in the intervention group. The intervention was found to result in a net gain of 0.046 quality-adjusted life-years over 3 years at a cost of £168 per patient, with an incremental cost-effectiveness ratio of £3643 and a probability of 0.86 of being cost-effective at a willingness-to-pay threshold of £20,000.

Conclusions

We developed and validated a risk score for detecting those at high risk of undiagnosed PDM/T2DM. We screened > 3400 people using a two-stage screening programme. The RCT showed that a relatively low-resource pragmatic programme may lead to a reduction in T2DM and improved biomedical and psychosocial outcomes, and is cost-effective.

Limitations

Only 19% of those invited to screening attended, which may limit generalisability. The variation in cluster size in the RCT may have limited the power of the study.

Future work

Future work should focus on increasing attendance to both screening and prevention programmes and offering the programme in different modalities, such as web-based modalities. A longer-term follow-up of the RCT participants would be valuable.

Trial registration

Current Controlled Trials ISRCTN80605705.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Evaluation of the Japanese Metabolic Syndrome Risk Score (JAMRISC): a newly developed questionnaire used as a screening tool for diagnosing metabolic syndrome and insulin resistance in Japan

Objectives

To prevent the onset of lifestyle-related diseases associated with metabolic syndrome (MetS) in Japan, research into the development of a useful screening method is strongly desired. We developed a new screening questionnaire (JAMRISC) utilizing a logistic regression model and evaluated its ability to predict the development of MetS, type 2 diabetes and other lifestyle-related diseases in Japanese populace.

Methods

JAMRISC questionnaire was sent to 1,850 individuals in Rumoi, a small city in Hokkaido. We received a total of 1,054 valid responses. To maximize the target individuals accurately diagnosed with MetS, logistic regression analysis was used to generate a unique metabolic syndrome score calculation formula as taking into consideration the clinical relevance of each question item as individual coefficients.

Results

The results of our comparative research utilizing both JAMRISC and Finnish Diabetes Risk Score (FINDRISC) questionnaires revealed the usefulness of JAMRISC for its ability to detect risks for MetS, pre-MetS, diabetes, and pre-diabetes. Study of disease risk detection via JAMRISC questionnaire targeting the 4283 residents of Rumoi indicated a high detection rate for pre-MetS (98.8 %), MetS (94.2 %), pre-diabetes (85.1 %) and type 2 diabetes (94.9 %). In addition, JAMRISC was useful not only as a MetS risk score test, but also as a screening tool for diagnosing insulin resistance.

Conclusions

JAMRISC questionnaire is a useful instrument for the detection of early risk of not only MetS and type 2 diabetes but also insulin resistance.

Screening for type 2 diabetes mellitus in overweight and obese subjects made easy by the FINDRISC score

AIM

To evaluate the use of the FINDRISC score in an overweight and obese population to predict glucose status.

METHODS

In 651 overweight/obese subjects (M/F: 193/458, age 43±13 y, BMI 38.2±6.1kg/m(2)) glucose status was tested using OGTT and HbA1c. Furthermore, the FINDRISC questionnaire and CT visceral fat (VAT) and subcutaneous fat (SAT) were examined.

RESULTS

Exactly 50.4% were found to have prediabetes and 11.1% were newly diagnosed with type 2 diabetes (T2DM) (M/F=22.2/8.8%). Subjects without T2DM had a FINDRISC score of 11±3, those with pre-DM 13±4, and subjects with de novo T2DM 15±5. The aROC of the FINDRISC for detecting T2DM was 0.76 (95% CI 0.72-0.82), with 13 as cutoff point. The FINDRISC score correlated with VAT (r=0.34, p<0.001) and VAT/SAT ratio (r=0.39, p<0.001). The aROC of the FINDRISC to detect excess VAT was 0.79 (95%CI 0.72-0.84).

CONCLUSIONS

In a large group of overweight and obese subjects, 50.4% were found to have pre-DM and 11.1% were newly diagnosed with T2DM. The FINDRISC score increased with worsening of glucose tolerance status and proved to be an independent predictor of T2DM status, as did HOMA-B, HOMA-S and VAT. The FINDRISC can also function as a good tool to predict visceral obesity.

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

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.

Impact of sex and age on the performance of FINDRISC: the HUNT Study in Norway

OBJECTIVE

The Finnish Diabetes Risk Score (FINDRISC) is recommended as a screening tool for diabetes risk. However, there is a lack of well-powered studies examining the performance of FINDRISC by sex and age. We aim to estimate, by sex and age, the prevalence of elevated FINDRISC and positive predictive value (PPV) of FINDRISC for identifying impaired glucose metabolism (IGM) in a general Norwegian population.

RESEARCH DESIGN AND METHODS

We estimated the prevalence of elevated FINDRISC (≥15) among 47 694 adults in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006-08). Among 2559 participants who participated in oral glucose tolerance testing, we estimated the PPV of elevated FINDRISC for identifying unknown prevalent diabetes and other forms of IGM.

RESULTS

The prevalence of elevated FINDRISC was 12.1% in women, 9.6% in men, and increased from 1.5% at age 20-39 to 25.1% at age 70-79 years. The PPVs of elevated FINDRISC were 9.8% for diabetes, 16.9% for impaired glucose tolerance, 8.2% for impaired fasting glucose, and 34.9% for any form of IGM. The PPV for IGM was lower in women (31.2%) than in men (40.4%), and increased from 19.1% at age 20-39 to 55.5% at age ≥80 years.

CONCLUSIONS

FINDRISC identified more women than men as high-risk individuals for diabetes. FINDRISC had a high PPV for detecting prevalent IGM, and the PPV was higher in men than in women and in the older individuals. Our data indicate that the impact of sex and age on diabetes risk is not fully captured by FINDRISC, and that refinements to it might improve diabetes prediction.

Evaluation of the Finnish Diabetes Risk Score to predict type 2 diabetes mellitus in a Colombian population: A longitudinal observational study

AIM: To assess the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus (DM2) in a Colombian population.

METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects (age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital’s database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence.

RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women.

CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.

[Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society]

In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol

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.

A novel testing model for opportunistic screening of pre-diabetes and diabetes among U.S. adults

Objective

The study aim was to evaluate the performance of a novel simultaneous testing model, based on the Finnish Diabetes Risk Score (FINDRISC) and HbA1c, in detecting undiagnosed diabetes and pre-diabetes in Americans.

Research Design and Methods

This cross-sectional analysis included 3,886 men and women (≥ 20 years) without known diabetes from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2010. The FINDRISC was developed based on eight variables (age, BMI, waist circumference, use of antihypertensive drug, history of high blood glucose, family history of diabetes, daily physical activity and fruit & vegetable intake). The sensitivity, specificity, and the receiver operating characteristic (ROC) curve of the testing model were calculated for undiagnosed diabetes and pre-diabetes, determined by oral glucose tolerance test (OGTT).

Results

The prevalence of undiagnosed diabetes was 7.0% and 43.1% for pre-diabetes (27.7% for isolated impaired fasting glucose (IFG), 5.1% for impaired glucose tolerance (IGT), and 10.3% for having both IFG and IGT). The sensitivity and specificity of using the HbA1c alone was 24.2% and 99.6% for diabetes (cutoff of ≥6.5%), and 35.2% and 86.4% for pre-diabetes (cutoff of ≥5.7%). The sensitivity and specificity of using the FINDRISC alone (cutoff of ≥9) was 79.1% and 48.6% for diabetes and 60.2% and 61.4% for pre-diabetes. Using the simultaneous testing model with a combination of FINDRISC and HbA1c improved the sensitivity to 84.2% for diabetes and 74.2% for pre-diabetes. The specificity for the simultaneous testing model was 48.4% of diabetes and 53.0% for pre-diabetes.

Conclusions

This simultaneous testing model is a practical and valid tool in diabetes screening in the general U.S. population.

A risk assessment model for type 2 diabetes in Chinese

Aims

To develop a risk assessment model for persons at risk from type 2 diabetes in Chinese.

Materials and Methods

The model was generated from the cross-sectional data of 16246 persons aged from 20 years old and over. C4.5 algorithm and multivariate logistic regression were used for variable selection. Relative risk value combined with expert decision constructed a comprehensive risk assessment for evaluating the individual risk category. The validity of the model was tested by cross validation and a survey performed six years later with some participants.

Results

Nine variables were selected as risk variables. A mathematical model was established to calculate the average probability of diabetes in each cluster's group divided by sex and age. A series of criteria combined with relative RR value (2.2) and level of risk variables stratified individuals into four risk groups (non, low, medium and high risk). The overall accuracy reached 90.99% evaluated by cross-validation inside the model population. The incidence of diabetes for each risk group increased from 1.5 (non-risk group) to 28.2(high-risk group) per one thousand persons per year with six years follow-up.

Discussion

The model could determine the individual risk for type 2 diabetes by four risk degrees. This model could be used as a technique tool not only to support screening persons at different risk, but also to evaluate the result of the intervention.

Evaluation of Finnish Diabetes Risk Score in screening undiagnosed diabetes and prediabetes among U.S. adults by gender and race: NHANES 1999-2010

Objective

To evaluate the performance of Finnish Diabetes Risk Score (FINDRISC) in detecting undiagnosed diabetes and prediabetes among U.S. adults by gender and race.

Methods

This cross-sectional analysis included participants (aged ≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 1999–2010. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and the optimal cutoff points for identifying undiagnosed diabetes and prediabetes were calculated for FINDRISC by gender and race/ethnicity.

Results

Among the 20,633 adults (≥20 years), 49.8% were women and 53.0% were non-Hispanic White. The prevalence of undiagnosed diabetes and prediabetes was 4.1% and 35.6%, respectively. FINDRISC was positively associated with the prevalence of diabetes (OR = 1.48 for 1 unit increase, p<0.001) and prediabetes (OR = 1.15 for 1 unit increase, p<0.001). The area under ROC for detecting undiagnosed diabetes was 0.75 for total population, 0.74 for men and 0.78 for women (p = 0.04); 0.76 for White, 0.76 for Black and 0.72 for Hispanics (p = 0.03 for White vs. Hispanics). The area under ROC for detecting prediabetes was 0.67 for total population, 0.66 for men and 0.70 for women (p<0.001); 0.68 for White, 0.67 for Black and 0.65 for Hispanics (p<0.001 for White vs. Hispanics). The optimal cutoff point was 10 (sensitivity = 0.75) for men and 12 (sensitivity = 0.72) for women for detecting undiagnosed diabetes; 9 (sensitivity = 0.61) for men and 10 (sensitivity = 0.69) for women for detecting prediabetes.

Conclusions

FINDRISC is a simple and non-invasive screening tool to identify individuals at high risk for diabetes in the U.S. adults.

Evaluation of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for the metabolic syndrome

OBJECTIVES

Traditionally, the Finnish Diabetes Risk Score (FINDRISC) questionnaire is a screening tool to estimate risk of type 2 diabetes. In this study, we evaluated the ability of FINDRISC to predict the development of the metabolic syndrome (MetS) in an Iranian population without diabetes and MetS.

METHODS

A total of 1,010 first-degree relatives of consecutive patients with type 2 diabetes, 30-70 years old (274 men and 736 women), without diabetes and MetS, were examined and followed up over 8.0 ± 1.6 years (mean ± SD) for MetS incidence. The incidence of MetS was examined across quartiles of FINDRISC, and a receiver operating characteristic (ROC) curve was plotted to assess the discrimination. At baseline and through follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). Data for determining FINDRISC were available from each participant.

RESULTS

During 8,089 person-years of follow-up, 69 men and 209 women without MetS and diabetes at baseline subsequently developed MetS. The incidence of MetS was 31.4 per 1000 person-years in men and 35.5 in women. The FINDRSC at baseline was significantly associated with MetS evolution. Participants in the top quartile of FINDRISC were 4.4 times more likely to develop MetS than those in the bottom quartile (rate ratio 4.4; 95% CI 2.7-7.0). The area under the ROC curve was 65.0% (95% CI 61.3-68.7).

CONCLUSION

The results of this study suggest that FINDRISC can be applied to detect MetS in a high-risk population.

Finnish Diabetes Risk Score to predict type 2 diabetes in the Isfahan diabetes prevention study

AIM

The strong association between the Finnish Diabetes Risk Score (FINDRISC) and risk of diabetes reported in European populations cannot necessarily be generalized to other populations. The aim of this study was to evaluate the ability of FINDRISC to predict progression to diabetes in an Iranian population without diabetes.

METHODS

A total of 1537 first-degree relatives (FDR) without diabetes of consecutive people with type 2 diabetes 30-70 years old (376 men and 1161 women) were examined and followed for a mean (SD) of 7.8 (1.7) years for diabetes incidence. We examined the incidence of diabetes across quartiles of FINDRISC and plotted a receiver operating characteristic (ROC) curve to assess discrimination. At baseline and through follow-up, participants underwent a standard 75-g 2-h oral glucose tolerance test. Data for the FINDRISC were available from each participant.

RESULTS

During 12,046 person-years of follow-up, 41 men and 154 women developed diabetes. The incidence of type 2 diabetes was 14.0 per 1000 person-years in men and 16.9 in women. Those in the top quartile of FINDRISC were 21.7 times more likely to develop diabetes than those in the bottom quartile (relative risk 21.7; 95% CI 9.90, 47.39). The area under the ROC was 75.1% (95% CI 71.3, 78.8).

CONCLUSIONS

The results of this study show that FINDRISC is a robust predictor of type 2 diabetes in high-risk individuals in Iran.

The performance of the Finnish Diabetes Risk Score, a modified Finnish Diabetes Risk Score and a simplified Finnish Diabetes Risk Score in community-based cross-sectional screening of undiagnosed type 2 diabetes in the Philippines

AIM

The performance of the Finnish Diabetes Risk Score (FINDRISC) and 2 modifications in community screening for undiagnosed type 2 diabetes (UDD) in the Philippines was evaluated.

METHODS

Active community-based screening for diabetes was conducted where FINDRISC assessment was done. Modified (modFINDRISC) and simplified (simpFINDRISC) versions were rendered based on Asian standards, study results, and local context. Diabetes was diagnosed through 2 separate blood glucose tests. Areas under the receiver operating characteristic curve (ROC-AUC) and statistics for diagnostic tests for FINDRISC and the modifications were analyzed.

RESULTS

Complete data was collected from 1752 people aged 20-92; 8.6% tested positive for diabetes. ROC-AUC for UDD were 0.738 (FINDRISC), 0.743 (modFINDRISC) and 0.752 (simpFINDRISC). The differences between the FINDRISC and the modifications were not statistically significant (p=0.172).

CONCLUSIONS

The performance of all 3 risk score calculators in the screening for UDD in the Philippines was good and may be useful in populations having similar characteristics. Considering the setting and resource constraints, the simpFINDRISC is preferred.