Abstract
This study aimed to develop a simple risk score for detecting individuals with undiagnosed type 2 diabetes mellitus in a Southern Chinese population. A sample of participants from the 2006–2007 Guangzhou type 2 diabetes cross-sectional study, aged 20 years and above, was used to develop scores for men and women separately by multiple logistic regression analysis. External validation was performed based on three other type 2 diabetes studies (the Zhuhai rural sample, the 2008–2010 Guangzhou urban sample, and the Tibet sample). Performances of the scores were measured using Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) c-statistic. Age, waist circumference, BMI, and family history of diabetes were included in the risk score for both men and women, and the risk factor of hypertension was included for men. The ROC c-statistics were 0.70 for men and 0.78 for women in the Zhuhai rural sample, and 0.76 for men and 0.69 for women in the 2008–2010 Guangzhou urban sample. At the risk score value of ≥36 for men and ≥28 for women, the scores gave a sensitivity, specificity, positive predictive value, and negative predictive value of 56.3, 73.2, 9.0, and 97.0 % for men and 62.5, 76.7, 11, and 97.0 % for women in the Zhuhai sample, respectively. In the 2008–2010 Guangzhou urban sample, the above measures are 85.7, 60.5, 3, and 100 % for men and 77.3, 53.0, 2, and 99 % for women. However, the scores performed poorly in the Tibet sample. The results indicate that the simple diabetes risk scores can be generalized in the Guangzhou city and the nearby rural regions and thus can help primary health care workers to identify individuals with undiagnosed type 2 diabetes.
Similar content being viewed by others
References
King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.
Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16:642–52.
Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44.
Age, body mass index and glucose tolerance in 11 European population-based surveys. Diabet Med. 2002;19:558–65.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359:2072–7.
Baan CA, Ruige JB, Stolk RP, Witteman JC, Dekker JM, Heine RJ, et al. Performance of a predictive model to identify undiagnosed diabetes in a health care setting. Diabetes Care. 1999;22:213–9.
Griffin SJ, Little PS, Hales CN, Kinmonth AL, Wareham NJ. Diabetes risk score: towards earlier detection of type 2 diabetes in general practice. Diabetes Metab Res Rev. 2000;16:164–71.
Glumer C, Carstensen B, Sandbaek A, Lauritzen T, Jorgensen T, Borch-Johnsen K. A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care. 2004;27:727–33.
Bang H, Edwards AM, Bomback AS, Ballantyne CM, Brillon D, Callahan MA, et al. Development and validation of a patient self-assessment score for diabetes risk. Ann Intern Med. 2009;151:775–83.
Al-Lawati JA, Tuomilehto J. Diabetes risk score in Oman: a tool to identify prevalent type 2 diabetes among Arabs of the Middle East. Diabetes Res Clin Pract. 2007;77:438–44.
Ramachandran A, Snehalatha C, Vijay V, Wareham NJ, Colagiuri S. Derivation and validation of diabetes risk score for urban Asian Indians. Diabetes Res Clin Pract. 2005;70:63–70.
Xin Z, Yuan J, Hua L, Ma YH, Zhao L, Lu Y, et al. A simple tool detected diabetes and prediabetes in rural Chinese. J Clin Epidemiol. 2010;63:1030–5.
Gao WG, Dong YH, Pang ZC, Nan HR, Wang SJ, Ren J, et al. A simple Chinese risk score for undiagnosed diabetes. Diabet Med. 2010;27:274–81.
Ko G, So W, Tong P, Ma R, Kong A, Ozaki R, et al. A simple risk score to identify Southern Chinese at high risk for diabetes. Diabet Med. 2010;27:644–9.
Glumer C, Vistisen D, Borch-Johnsen K, Colagiuri S. Risk scores for type 2 diabetes can be applied in some populations but not all. Diabetes Care. 2006;29:410–4.
Nyamdorj R, Pitkaniemi J, Tuomilehto J, Hammar N, Stehouwer CD, Lam TH, et al. Ethnic comparison of the association of undiagnosed diabetes with obesity. Int J Obes (Lond). 2010;34:332–9.
Mann DM, Bertoni AG, Shimbo D, Carnethon MR, Chen H, Jenny NS, et al. Comparative validity of 3 diabetes mellitus risk prediction scoring models in a multiethnic US cohort: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2010;171:980–8.
Wang H, Qiu Q, Tan LL, Liu T, Deng XQ, Chen YM, et al. Prevalence and determinants of diabetes and impaired fasting glucose among urban community-dwelling adults in Guangzhou, China. Diabetes Metab. 2009;35:378–84.
World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1. Diagnosis and classification of diabetes mellitus. Geneva: World Health Organization; 1999.
Xie J, Hu D, Yu D, Chen CS, He J, Gu D. A quick self-assessment tool to identify individuals at high risk of type 2 diabetes in the Chinese general population. J Epidemiol Community Health. 2010;64:236–42.
Gray LJ, Taub NA, Khunti K, Gardiner E, Hiles S, Webb DR, et al. The Leicester Risk Assessment score for detecting undiagnosed type 2 diabetes and impaired glucose regulation for use in a multiethnic UK setting. Diabet Med. 2010;27:887–95.
Acknowledgments
This study was funded by the Guangzhou Health Bureau (2005-Zda-001) and was completed with the assistance of the following units: Disease Prevention and Control Center of Haizhu District and Baiyun District, the Health Monitoring Institute of Huangpu District, the Sixth Affiliated Hospital of Sun Yat-Sen University, and the Health Care Center of Huayin Community.
Conflict of interest
The authors have not declared any conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, H., Liu, T., Qiu, Q. et al. Development and validation of a simple risk score for prevalent undiagnosed type 2 diabetes in Southern Chinese population. Int J Diabetes Dev Ctries 35, 318–326 (2015). https://doi.org/10.1007/s13410-014-0285-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-014-0285-9