Validation of DIABSCORE in screening for Type 2 Diabetes and prediabetes in Tunisian population

Abstract

AimsTo perform a validation of DIABSCORE in a sample of Tunisian adults and find out the optimal cut-off point for screening of Type 2 diabetes (T2D) and prediabetes.Methods225 adults 18–75 years and a subgroup of 138 adults (18–54 years), with undiagnosed T2D from the region of Cap-Bon, Tunisia were included in the present study. The DIABSCORE was calculated based on: age, waist/height ratio, family history of T2D and gestational diabetes. Receiver operating characteristics (ROC) curves and areas under curve (AUC) were obtained. The T2D and prediabetes prevalences odds ratios (OR) between patients exposed and not exposed to DIABSCORE≥90 and DIABSCORE≥80, respectively were calculated in both age ranges.ResultsFor screening of T2D the best value was DIABSCORE = 90 with a highest sensitivity (Se), negative predictive value (NPV) and lower negative likelihood ratio in participants aged 18–75 yr (Se = 97%; NPV = 97%) when compared to participants aged 18–54 yr (Se = 95%; NPV = 97%); for prediabetes, the best Se and NPV were for DIABSCORE = 80 in both age groups, but it showed a disbalanced sensitivity-specificity. The ROC curves for T2D showed a similar AUC in both age ranges (AUC = 0.62 and AUC = 0.61 respectively). The ROC curves for prediabetes showed a highest AUC in those aged 18–54 years than the older ones (AUC = 0.62 and AUC = 0.57, respectively). The prevalences OR of T2D for DIABSCORE≥90 was higher than for DIABSCORE≥80 in both age ranges. Nevertheless, the prevalences OR of prediabetes for DIABSCORE≥90 was half of the detected for DIABSCORE≥80 in both age ranges.ConclusionThe DIABSCORE is a simple clinical tool and accurate method in screening for T2D and prediabetes in the adult Tunisian population.

A meta‐analysis of diabetes risk prediction models applied to prediabetes screening

“…Twenty‐four diagnostic trials were assessed for risk of bias and suitability according to the QUADAS‐2 evaluation form. Thirteen 24,26,28,31,35–40,43,45,48 (54.2%) of the 24 studies were judged to be at unclear risk of bias, six 25,29,34,44,46,47 (25%) at high risk of bias, and five 27,30,41,42,49 (20.8%) at low risk of bias.…”

“…With regard to selection of gold standard testing methods, all of the studies chose the currently recognized laboratory testing methods, and the disease differentiation was good. Regarding case flow and progression, with the exception of the study by Scanlan et al, 34 which did not include all study subjects in the outcome analysis, and the gold standard of Poltavskiy et al, 25 Zhang et al 44 and Gannar et al 46 was not specified, this means that in these studies, screening and testing were performed almost simultaneously, so there were four high‐risk studies. All studies performed well in clinical suitability assessments, therefore, none was categorized as high‐risk in this regard.…”

“…Thirteen 24,26,28,31,[35][36][37][38][39][40]43,45,48 (54.2%) of the 24 studies were judged to be at unclear risk of bias, six 25,29,34,44,46,47 (25%) at high risk of bias, and five 27,30,41,42,49 The study population as a family practice population.…”

Prevalence and correlates of pre-diabetes in Sub-Saharan Africa using Demographic and Health Survey Data: a cross-sectional study

“…In addition to prevention interventions, regular screening with fasting blood glucose is an important method of secondary prevention that needs wider implementation across nations with expected growth in pre-diabetes prevalence 22. A number of screening tools may perform better than others on certain populations, for example, the DIABSCORE was validated in Tunisian adults to be specific for that population 23…”

“…22 A number of screening tools may perform better than others on certain populations, for example, the DIABSCORE was validated in Tunisian adults to be specific for that population. 23 Despite limited resources for national prevention of chronic disease, lifestyle interventions with proven costeffectiveness and societal interventions that promote healthy diet and increased physical activity are needed to combat expected trends in pre-diabetes. 24 A culturally adapted programme to prevent diabetes in Malaysia reduced several risk factors and improved quality of life in those with pre-diabetes.…”