Community Based Screening for Diabetes and Prediabetes using the Indian Diabetes Risk Score among Adults in a Semi-Urban Area in Kathmandu, Nepal

Abstract

Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of <30 are categorized as low risk, 30-50 as medium risk and those with > 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.

Evaluation of Fasting Capillary Glucose and Fasting Plasma Glucose as Screening Tests for Diabetes and Prediabetes among Adults in a Semi-Urban Area in the Kathmandu District, Nepal

“…Within 95% confidence intervals, IDRS was able to identify between 62% to 77% of the persons with raised blood glucose in comparison to 78% to 97% for FPG. 16 Combining the IDRS with FCG estimation may increase the sensitivity and increase the yield during community based screening. 29 Amongst the study participants, a larger proportion of prediabetes was seen in comparison to undiagnosed diabetes.…”

“…It is comprised of four scored questions regarding age, abdominal obesity as measured by the waist circumference, family history of diabetes and physical activity levels. 15 During a study that was planned to assess the performance of the IDRS as a screening tool among an adult population in a semi-urban setting in the Kathmandu district, Nepal, 16 the performance of FCG was evaluated in comparison with FPG measurement in screening for diabetes and prediabetes. The concordance between FCG, FPG and 2 hr PG measurements was also assessed.…”

“…Three participants were tested for plasma glucose levels after a meal (post prandial) as they either vomited or were unable to drink the glucose solution. 16 Data Analysis: Collected data was entered into forms designed in EPI-INFO version 7.2 and data was analysed using Stata 15IC licensed software.…”

Clinical Laboratorial Perspective on Screening of Prediabetes and need for Standardization of Post Prandial Blood Glucose Testing in Nepal

“…10 Similarly, the prevalence of prediabetes in a community-based study done in Nepal, is reported to be 7.14%. 11 In our experience, prediabetes is often an incidental diagnosis in people who undergo a routine physical workup or perhaps a screening for diabetes.…”

Participants’ Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals

“…For these reasons, community-based intervention programs are vital for investigating the actual outcome of lifestyle intervention that can be utilized as the prototype to develop the precise intervention in greater scale. Despite the fact that community-based intervention programs are catered for lifestyle changes, 4 only a few temple-based qualitative research studies were conducted especially topic related to lifestyle intervention owing to lifestyle modification is delicate due to it involves with knowledge, support, motivation, attitudes, behaviors, understanding and real practice, moreover, most of the existing researches associated with diabetes and/or hypertension lifestyle intervention at community-based level in Thailand were quantitative studies 2,3,5 -8 in a similar way of worldwide existing researches 9 -30 and current lifestyle interventions in Thailand seem less important for people to accept to use in their own lifestyle. For these reasons, hypertension and type 2 diabetes mellitus still spread out among Thai people.…”