Three‐component non‐invasive risk score for undiagnosed diabetes in Chinese people: Development, validation and longitudinal evaluation

Abstract

Aims/Introduction To develop a new non‐invasive risk score for undiagnosed diabetes in Chinese people, and to evaluate the incident diabetes risk in those with high‐risk scores, but no diabetes on initial testing. Materials and Methods A total of 2,609 participants with no known diabetes (aged 25–74 years) who underwent oral glucose tolerance tests in Hong Kong (HK) were investigated for independent risk factors of diabetes to develop a categorization point scoring system, the Non‐invasive Diabetes Score (NDS). This NDS was validated in a cross‐sectional study of 2,746 participants in Shaanxi, China. HK participants tested to not have diabetes at baseline were assessed for subsequent incident diabetes rates. Results In the HK cohort, hypertension, age and body mass index were the key independent risk factors selected to develop the NDS, with ≥28 out of 50 NDS points considered as high risk. The area under the receiver operating characteristic curve for undiagnosed diabetes was 0.818 and 0.720 for the HK and Shaanxi cohort, respectively. The negative predictive value was 97.4% (HK) and 95.8% (Shaanxi); the number needed to screen to identify one case of diabetes was five (HK) and 11 (Shaanxi), respectively. Among those that tested non‐diabetes at baseline, individuals with NDS ≥28 had a threefold risk of incident diabetes during the subsequent 20.9 years, compared with those with NDS <28 (P < 0.001), with a steeper rise in incident diabetes observed in those with NDS at higher tertiles. Conclusions This new three‐component risk score is a user‐friendly tool for diabetes screening, and might inform the subsequent testing interval for high‐risk non‐diabetes individuals.

Development and validation of a diabetes mellitus and prediabetes risk prediction function for case finding in primary care in Hong Kong: a cross-sectional study and a prospective study protocol paper

“…The third Hong Kong model, the Non-invasive Diabetes Score (NDS), used only three non-invasive factors (ie, age, BMI and diagnosis of hypertension) to develop a risk score system. 22 At a cut-off score of ≥28/50, the model showed good discrimination (AUC: 0.720) with an external validation sample, which consisted of mainland Chinese. Also, sensitivity and specificity were reported as 60.8% and 69.7%, respectively.…”

“…Since 2009, several DM risk prediction models and scoring algorithms have been developed specifically for Chinese populations 3 17–22. The majority of these models and algorithms were developed and validated in Mainland China,17–21 with only three models developed for the Hong Kong Chinese population 3 17 22. The first Hong Kong model used self-reported factors and laboratory measurements to create a scoring algorithm 3.…”

“…The application of this risk prediction model is limited because the sample was predominately male (92.7%), and the accuracy was modest. The third Hong Kong model, the Non-invasive Diabetes Score (NDS), used only three non-invasive factors (ie, age, BMI and diagnosis of hypertension) to develop a risk score system 22. At a cut-off score of ≥28/50, the model showed good discrimination (AUC: 0.720) with an external validation sample, which consisted of mainland Chinese.…”

Non‐laboratory‐based risk assessment model for case detection of diabetes mellitus and pre‐diabetes in primary care

“…Model calibration was assessed by calibration plots 37 , 38 and the Hosmer‐Lemeshow test, to measure how well the predicted risk agreed with the observed event rate. Two existing diabetes mellitus risk models specific for the Chinese population, the NCDRS 18 and the NDS 19 , and the screening recommendation by the Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings 12 were also applied to the validation sample for performance comparison of detecting diabetes mellitus and pre‐diabetes mellitus, and diabetes mellitus only. The AUC‐ROCs of different models were compared using DeLong’s test 39 , and the AUC‐PRs were compared using a bootstrap‐based test 40 with MedCalc 19.8.…”

“…The most widely used are the ADA Risk Test 13 , the Leicester Self‐Assessment score adopted by the UK National Institute for Health and Care Excellence (NICE) 14 , the Australian type 2 diabetes risk assessment tool (AUSDRISK) 15 , and the Canadian Diabetes Risk Questionnaire (CANRISK) 16 , but these models developed based on Caucasian populations may not be applicable to the Chinese population 17 . The New Chinese Diabetic Risk Score (NCDRS) 18 and the Non‐invasive Diabetes Score (NDS) 19 were developed from cohorts of Chinese adults and appeared to be more accurate than the ADA Risk Test for Chinese. However, these existing models are all intended for the risk assessment of diabetes mellitus and none has been developed for identifying pre‐diabetes mellitus.…”