Use of the Diabetes Risk Score for Opportunistic Screening of Undiagnosed Diabetes and Impaired Glucose Tolerance

Abstract

OBJECTIVE -To evaluate an opportunistic screening strategy addressed to individuals with one or more cardiovascular risk factor, based on the Diabetes Risk Score (DRS) as the initial instrument, for the identification of individuals with type 2 diabetes or impaired glucose tolerance (IGT).RESEARCH DESIGN AND METHODS -The DRS, a simple self-administered questionnaire, was completed by individuals identified by general practitioners and presenting with one or more cardiovascular risk factor. All patients underwent a 2-h oral glucose tolerance test (OGTT). The optimal DRS cutoff was calculated by applying the receiver-operating characteristic curve.RESULTS -Overall, 1,377 individuals aged between 55 and 75 years received an OGTT and completed the DRS. Mean DRS values showed a marked variation according to glucose metabolism categories, as follows: 8.7 Ϯ 3.0 in normoglycemic individuals, 9.5 Ϯ 3.1 in individuals with impaired fasting glucose, 9.9 Ϯ 3.3 in individuals with IGT, and 12.0 Ϯ 3.5 in individuals with type 2 diabetes. The receiver-operating characteristic curve showed that, with a cutoff of 9, the sensitivity of DRS in detecting individuals with glucose abnormalities (type 2 diabetes or IGT) was 77% and the specificity 45%. The use of the DRS as an initial screening instrument, followed by the measurement of fasting blood glucose in individuals with a score Ն9 and by the OGTT in individuals with a fasting blood glucose between 5.6 and 6.9 mmol/l, would lead to the identification of 83% of the case subjects with type 2 diabetes and 57% of the case subjects with IGT, at a cost of an OGTT in 38% of the sample and a fasting blood glucose in 64%.CONCLUSIONS -The DRS can represent a valid inexpensive instrument for opportunistic screening and a useful alternative to indiscriminate fasting blood glucose measurement, not readily available in general practice. Diabetes Care 28:1187-1194, 2005T he prevalence of type 2 diabetes is rapidly growing worldwide (1,2). This condition exerts a pernicious effect on patient health and health care budgets, and early detection of subjects with undiagnosed diabetes might be important in reducing the burden of diabetic complications. This is of particular importance considering that diabetes is frequently not diagnosed until complications appear, and approximately onethird of all people with diabetes may be undiagnosed (3).Recent experimental evidence has shown that type 2 diabetes can be prevented or delayed by implementing lifestyle modifications (e.g., diet and exercise) or using pharmacological treatment (metformin or acarbose) in individuals with impaired glucose tolerance (IGT) (4 -7). These findings have provided the rationale for screening IGT. This condition is defined using a 2-h oral glucose tolerance test (OGTT), a kind of test that is often considered to entail enough discomfort to discourage its indiscriminate use. Identifying people at increased risk for undiagnosed diabetes or glucose intolerance, followed by blood glucose testing to establish diagnosis, is consid...

Relationship of elevated casual blood glucose level with coronary heart disease, cardiovascular disease and all-cause mortality in a representative sample of the Japanese population. NIPPON DATA80

“…Recently, diabetes risk scores incorporating age, sex, BMI, steroid or antihypertensive medication, family history, smoking history and other factors have been accepted as the most appropriate tool for initial diabetes mellitus screening [28][29][30]. The use of such a risk score might also be feasible for initial screening, although its value has yet to be established in the Japanese population.…”

Random Plasma Glucose in Serendipitous Screening for Glucose Intolerance: Screening for Impaired Glucose Tolerance Study 2

“…Questionnaires based on symptoms and risk factors have also been developed as inexpensive strategies to identify patients who need further evaluation. Although some questionnaires have been reported to provide AROC for diabetes~0.80, [36][37][38] comparable to that of screening with RPG, most provide 0.70-0.75, [39][40][41] and some that initially appeared promising had lower performance when applied to a separate population in the same city. 42 In the USA, it has been estimated that diabetes goes on for 10 years before clinical recognition, 43 and longer delay leads to higher glucose levels at the time of diagnosis.…”

Type 2 Diabetes Mellitus in Family Practice: Prevention and Screening

“…Echouffo-Tcheugui et al, 2009;Edelman et al, 2002a;Franciosi et al, 2005;Greaves et al, 2004;Goyder et al, 2008;Janssen et al, 2007;O'Connor et al, 2001;Woolthuis et al, 2009). Many have employed a 'stepwise' approach, whereby participants progress through increasingly invasive screening procedures until they are diagnosed with diabetes or found not to have the condition.…”

“…The number of steps in the screening process varies across studies. Typically, in the first step, potential screening participants are identified by:  their responses on a self-completed questionnaire that assesses their risk of diabetes, such as the FINDRISC (Saaristo et al, 2005), the Symptom Risk Questionnaire (Adriaanse et al, 2002) or the Diabetes Risk Score (Franciosi et al, 2005); or  using the GP electronic medical records to search for people who match specific risk criteria (e.g. Greaves et al, 2004); or  using a standardised risk calculator based on clinical data held on the computerised medical record to assess the patient's risk of diabetes, such as the Cambridge Risk Score or QDRISK (Hippisley- Cox et al, 2009).…”

“…Further dropout is evident at the later stages of many of the stepwise screening processes, whereby individuals who have abnormal results in initial tests fail to return for further tests (Woolthuis et al, 2009), particularly where this involves more invasive or complex tests or where the patient is referred to an outpatient clinic (e.g. Franciosi et al, 2005;Janssen et al, 2007;O'Connor et al, 2001). …”