Skip to main content
SpringerLink
Log in

Derivation and external validation of a simple prediction model for the diagnosis of type 2 Diabetes Mellitus in the Brazilian urban population

  • DIABETES
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

A risk score model was developed based in a population of 1,224 individuals from the general population without known diabetes aging 35 years or more from an urban Brazilian population sample in order to select individuals who should be screened in subsequent testing and improve the efficacy of public health assurance. External validation was performed in a second, independent, population from a different city ascertained through a similar epidemiological protocol. The risk score was developed by multiple logistic regression and model performance and cutoff values were derived from a receiver operating characteristic curve. Model’s capacity of predicting fasting blood glucose levels was tested analyzing data from a 5-year follow-up protocol conducted in the general population. Items independently and significantly associated with diabetes were age, BMI and known hypertension. Sensitivity, specificity and proportion of further testing necessary for the best cutoff value were 75.9, 66.9 and 37.2%, respectively. External validation confirmed the model’s adequacy (AUC equal to 0.72). Finally, model score was also capable of predicting fasting blood glucose progression in non-diabetic individuals in a 5-year follow-up period. In conclusion, this simple diabetes risk score was able to identify individuals with an increased likelihood of having diabetes and it can be used to stratify subpopulations in which performing of subsequent tests is necessary and probably cost-effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ADA:

American Diabetes Association

AUC:

Area under curve

BMI:

Body mass index

CVD:

Cardiovascular diseases

DBP:

Diastolic blood pressure

EPV:

Events per variable

FPG:

Fasting plasma glucose

HDL-c:

High density lipoprotein cholesterol

IFG:

Impaired fasting glycemia

IGT:

Impaired glucose tolerance

LDL-c:

Low density lipoprotein cholesterol

OGTT:

Oral glucose tolerance test

PCOS:

Polycystic ovarian syndrome

ROC curve:

Receiver operating characteristic curve

SBP:

Systolic blood pressure

T2DM:

Type 2 Diabetes Mellitus

References

  1. Incidence of diabetes in the population aged 18–79 Years. Cent Dis Control Prev. 2006. http://www.cdc.go/diabetes/statistics/incidence. Accessed Aug 2006.

  2. Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr. The Brazilian Cooperative Group on the study of diabetes prevalence. Diabetes Care. 1992;15(11):1509–16.

    Article  PubMed  CAS  Google Scholar 

  3. Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16(4):642–52.

    PubMed  CAS  Google Scholar 

  4. 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(1):63–70.

    Article  PubMed  CAS  Google Scholar 

  5. 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(3):727–33.

    Article  PubMed  Google Scholar 

  6. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90(1):583–612.

    PubMed  CAS  Google Scholar 

  7. Bisi Molina Mdel C, Cunha Rde S, Herkenhoff LF, Mill JG. Hypertension and salt intake in an urban population. Rev Saude Publica. 2003;37(6):743–50.

    PubMed  Google Scholar 

  8. Candido AP, Ferreira S, Lima AA, de Carvalho Nicolato RL, de Freitas SN, Brandao P, et al. Lipoprotein(a) as a risk factor associated with ischemic heart disease: Ouro Preto study. Atherosclerosis. 2007;191(2):454–9.

    Article  PubMed  CAS  Google Scholar 

  9. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2008;31(Suppl 1):S55–60.

    Article  CAS  Google Scholar 

  10. Pesquisa por amostra de domicílios 2000: microdados. Rio de Janeiro: Fundação Instituto Brasileiro de Geografia e Estatística; 2001.

  11. Alves-Silva J, da Silva Santos M, Guimaraes PE, Ferreira AC, Bandelt HJ, Pena SD, et al. The ancestry of Brazilian mtDNA lineages. Am J Hum Genet. 2000;67(2):444–61.

    Article  PubMed  CAS  Google Scholar 

  12. Ferreira RG, Moura MM, Engracia V, Pagotto RC, Alves FP, Camargo LM, et al. Ethnic admixture composition of two western Amazonian populations. Hum Biol. 2002;74(4):607–14.

    Article  PubMed  CAS  Google Scholar 

  13. Marquezine GF, Oliveira CM, Pereira AC, Krieger JE, Mill JG. Metabolic syndrome determinants in an urban population from Brazil: social class and gender-specific interaction. Int J Cardiol. 2007;129:259–65.

    Article  PubMed  Google Scholar 

  14. 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(3):164–71.

    Article  PubMed  CAS  Google Scholar 

  15. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.

    Article  PubMed  Google Scholar 

  16. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136(8):575–81.

    PubMed  Google Scholar 

  17. Tabaei BP, Herman WH. A multivariate logistic regression equation to screen for diabetes: development and validation. Diabetes Care. 2002;25(11):1999–2003.

    Article  PubMed  Google Scholar 

  18. Spijkerman AM, Yuyun MF, Griffin SJ, Dekker JM, Nijpels G, Wareham NJ. The performance of a risk score as a screening test for undiagnosed hyperglycemia in ethnic minority groups: data from the 1999 health survey for England. Diabetes Care. 2004;27(1):116–22.

    Article  PubMed  Google Scholar 

  19. Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD. Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Mak. 2001;21(1):45–56.

    Article  CAS  Google Scholar 

  20. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997;277(6):488–94.

    Article  PubMed  CAS  Google Scholar 

  21. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.

    Article  PubMed  CAS  Google Scholar 

  22. Aekplakorn W, Bunnag P, Woodward M, Sritara P, Cheepudomwit S, Yamwong S, et al. A risk score for predicting incident diabetes in the Thai population. Diabetes Care. 2006;29(8):1872–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo [grant number 07/54138-2]

Author information

Authors and Affiliations

  1. Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, Av Dr. Enéas Carvalho de Aguiar, 44, Instituto do Coração, 10th Floor, São Paulo-SP, 05403-000, Brazil

    André Gustavo Pires de Sousa, Alexandre Costa Pereira, Guilherme Figueiredo Marquezine & José Eduardo Krieger

  2. Clinical Medicine Department, Federal University of Rio Grande do Norte, Natal, Brazil

    André Gustavo Pires de Sousa

  3. Arterial Hypertension Institute, Belo Horizonte, Brazil

    Raimundo Marques do Nascimento-Neto

  4. Federal University of Ouro Preto Medical School, Ouro Preto, Brazil

    Raimundo Marques do Nascimento-Neto

  5. Pharmacy Department, Federal University of Ouro Preto, Ouro Preto, Brazil

    Silvia N. Freitas, Roney Luiz de C. Nicolato & George Luiz Lins Machado-Coelho

  6. Department of Physiological Sciences, Federal University of Espirito Santo, Vitoria, Brazil

    Sérgio L. Rodrigues & José G. Mill

Authors
  1. André Gustavo Pires de Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre Costa Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guilherme Figueiredo Marquezine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raimundo Marques do Nascimento-Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvia N. Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roney Luiz de C. Nicolato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. George Luiz Lins Machado-Coelho
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sérgio L. Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. José G. Mill
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. José Eduardo Krieger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandre Costa Pereira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pires de Sousa, A.G., Pereira, A.C., Marquezine, G.F. et al. Derivation and external validation of a simple prediction model for the diagnosis of type 2 Diabetes Mellitus in the Brazilian urban population. Eur J Epidemiol 24, 101–109 (2009). https://doi.org/10.1007/s10654-009-9314-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-009-9314-2

Keywords

Search

Navigation