OBJECTIVE -The objective of this study was to develop and evaluate a risk score to predict people at high risk of diabetes in Thailand.RESEARCH DESIGN AND METHODS -A Thai cohort of 2,677 individuals, aged 35-55 years, without diabetes at baseline, was resurveyed after 12 years. Logistic regression models were used to identify baseline risk factors that predicted the incidence of diabetes; a simple model that included only those risk factors as significant (P Ͻ 0.05) when adjusted for each other was developed. The coefficients from this model were transformed into components of a diabetes score. This score was tested in a Thai validation cohort of a different 2,420 individuals.RESULTS -A total of 361 individuals developed type 2 diabetes in the exploratory cohort during the follow-up period. The significant predictive variables in the simple model were age, BMI, waist circumference, hypertension, and history of diabetes in parents or siblings A cutoff score of 6 of 17 produced the optimal sum of sensitivity (77%) and specificity (60%). The area under the receiver-operating characteristic curve (AUC) was 0.74. Adding impaired fasting glucose or impaired glucose tolerance status to the model slightly increased the AUC to 0.78; adding low HDL cholesterol and/or high triglycerides barely improved the model. The validation cohort demonstrated similar results.CONCLUSIONS -A simple diabetes risk score, based on a set of variables not requiring laboratory tests, can be used for early intervention to delay or prevent the disease in Thailand. Adding impaired fasting glucose or impaired glucose tolerance or triglyceride and HDL cholesterol status to this model only modestly improves the predictive ability. Diabetes Care 29:1872-1877, 2006A remarkable worldwide increase in the number of people with type 2 diabetes has been predicted (1). Prevalence rates in the developing world, particularly in the Asia-Pacific region, are already high and expected to rise more quickly than elsewhere. In Thailand, the prevalence of type 2 diabetes among the population aged Յ35 years was 9.6% in 2001, an increase of 20% over a period of 5 years (2). Cardiovascular disease (CVD) is one of the leading causes of death in Thailand (3), and individuals with diabetes have a two to fourfold greater risk of developing CVD than those without (4). The burden of diabetes and its complications, which include other diseases besides CVD (5), imposes a massive load on the Thai health care system. Lifestyle modification has been proven to effectively prevent and delay the development of diabetes (6 -8).Therefore, early recognition of and intervention for the condition will be beneficial, particularly as cardiovascular complications set in early after the onset of diabetes (9). Delay and lack of detection of the disease are mostly due to patients being asymptomatic during the early stage of the disease; hence an accurate screening tool to identify those at high risk of developing diabetes will be of great value. Knowledge of the risk of diabetes could enhance...

End-stage kidney disease has become an increasing burden in all regions of the world. However, limited epidemiologic data on chronic kidney disease in Southeast Asian populations are available. Therefore, a cohort study over a period of 12 yr (1985 to 1997) in 3499 employees of the Electric Generation Authority of Thailand, aged 35 to 55 yr, was conducted to determine the prevalence of decreased kidney function and risk factors associated with future development of decreased kidney function. The prevalence of decreased kidney function (GFR <60 ml/min) increased from 1.7% (95% confidence interval [CI], 1.3 to 2.1) in 1985 to 6.8% (95% CI, 5.7 to 7.9) in 1997, and the prevalence of elevated serum creatinine was 6.1% (95% CI, 5.3 to 6.9) and 16.9% (95% CI, 15.3 to 18.5) in 1985 and 1997 surveys, respectively. The adjusted odds ratio for future development of decreased kidney function was 2.57 (1.0 to 6.81) for systolic hypertension (>159 mmHg), 1.82 (1.12 to 2.98) for hyperuricemia (>6.29 mg/dl), 1.68 (1.02 to 2.77) for elevated body mass index (>24.9 kg/m 2 ) compared with subjects with systolic BP <140 mmHg, serum uric acid <4.5 mg/dl, and body mass index 20.8 to 22.8 kg/m 2 . The rising prevalence of decreased kidney function in this population resulted mainly from the increasing prevalence of the risk factors in the population. Screening to detect decreased kidney function and early intervention to modify the associated risk factors should be considered in otherwise healthy individuals. Future studies are also necessary to determine whether implementation of these measures results in a reduction of ESRD incidence in the population.

US adults with metabolic syndrome, as defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, have been shown to be at increased risk of chronic kidney disease (CKD), but there is limited information in other populations. The relationship between metabolic syndrome and CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2)) was examined in a Southeast Asian cohort. This relationship was examined when the subjects (n=3195) were initially recruited in a cross-sectional analysis. The risks of developing new CKD associated with metabolic syndrome were also examined prospectively in a subgroup (n=2067) without CKD at entry after 12 years follow-up. Metabolic syndrome was defined according to both NCEP ATP III and the new International Diabetes Federation (IDF) criteria. The prevalence of CKD was 1.6%, and the incidence of new CKD was 6.3%. Metabolic syndrome by NCEP ATP III definition was associated with the increased risk of CKD at baseline (adjusted odds ratio (OR) 2.48 and 95% confidence interval 1.33-4.62), and of developing new CKD at follow-up (adjusted OR 1.62 and 95% confidence interval 1.00-2.61). There was a significant graded relationship between the number of metabolic syndrome components present and risk of CKD. By contrast, metabolic syndrome by IDF definition was not associated with increased risk of CKD. These results suggest the relationship between CKD and metabolic syndrome in a Southeast Asian population is highly dependent on the criteria used to define metabolic syndrome.