Validation of Indian diabetic risk score in diagnosing type 2 diabetes mellitus against high fasting blood sugar levels among adult population of central India

Abstract

Globally the increasing prevalence of diabetes mellitus (DM) is major public health concern. International Diabetes Federation has stated that in India alone, the number of people with DM is estimated to be 40.9 million and is expected to rise to 69.9 million by 2025.[1] The Indian Diabetes Risk Score (IDRS) was developed by Madras Diabetes Research Foundation (MDRF) as a simple tool to help detect undiagnosed type 2 DM (T2DM) in the community.[2] We conducted a study among 911 adults of Jabalpur District to detect the prevalence of hypertension in the year 2011-2012, which has been published earlier. [3] We further analyzed the data to validate the IDRS score against increased fasting blood sugar levels in diagnosing T2DM. T2DM was confirmed either by history of previously known disease or fasting plasma glucose ≥ 126 mg/dl on two occasions. Sensitivity, specificity, positive predictive value, negative predictive value, Youden index (sensitivity + specificity −1), likelihood ratio for positive test, and likelihood ratio for negative test were calculated for IDRS cut-offs of ≥20, ≥40, ≥60, and ≥80 against the presence of T2DM (either known diabetic or fasting plasma glucose >126 mg/dl on two occasions). The overall prevalence of T2DM was 9.99% (95% confidence interval, 8.04-11.94%). In the Receiver Operating Characteristic analysis, IDRS had an area under the curve of 0.736 and a p < 0.001. The best cut-off was IDRS ≥ 40 with a sensitivity, specificity, and Youden index of 60.4%, 70.7%, and 0.31, respectively [ Table 1]. The MDRF-IDRS was also validated in the Boloor Diabetes study in Karnataka state where using IDRS, screening of nearly one-third of the population of Boloor locality in Mangalore was done. In that study, using an IDRS score ≥ 60, 62.2% of people living with undiagnosed diabetes in that population could CorrespondenceGlobally the increasing prevalence of diabetes mellitus (DM) is major public health concern. The Indian Diabetes Risk Score (IDRS) was developed by Madras Diabetes Research Foundation (MDRF) as a simple tool to help detect undiagnosed type 2 DM (T2DM) in the community. We conducted a study among 911 adults of Jabalpur District to validate the IDRS score against increased fasting blood sugar levels in diagnosing T2DM. T2DM was confirmed either by history of previously known disease or fasting plasma glucose ≥126 mg/dl on two occasions. Sensitivity, specificity, positive predictive value, negative predictive value, Youden index (sensitivity + specificity −1), likelihood ratio for positive test, and likelihood ratio for negative test were calculated for IDRS cut-offs of ≥20, ≥40, ≥60, and ≥80 against the presence of T2DM (either known diabetic or fasting plasma glucose >126 mg/dl on two occasions). The overall prevalence of T2DM was 9.99% (95% confidence interval, 8.04-11.94%). In the Receiver operating characteristic analysis, IDRS had an area under the curve of 0.736 (P < 0.001). The best cut-off was IDRS 40 with a sensitivity, specificity, and Youden index of 60.4%, 70.7%, and 0.31, ...

Performance of Indian Diabetes Risk Score (IDRS) as screening tool for diabetes in an urban slum

“…[30][31][32] However, Bhadoria et al in their study among adult population in central India recommended the cut off value of 40. 33 Total area under ROC curve is a single index for measuring the performance a test. 34 An area of less than 0.6 is not significant.…”

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…[ 20 21 ] Studies from different regions of India including Jammu, Kashmir, Chennai, Haryana, Delhi, Jabalpur, and Kerala estimated the utility of MDRF-IDRS in identifying risk for DM and prediabetes in Indian adult population and found statistically significant association between IDRS and DM patients indicating MDRF-IDRS to be efficient tool to screen and diagnose the huge pool of undiagnosed diabetics in India. [ 53 54 55 56 57 58 ] ▫It is also found by that identifying the presence of multiple risk factors could be used as a simple measure of identifying people at high risk of diabetes. [ 59 ] ▫The panel suggests that individuals with diabetes or at risk of developing diabetes should be advised on lifestyle changes and implementing strategies focusing on diet, exercise and weight loss to prevent the risk of progression and thus complications of diabetes.…”

“…[ 20 21 ] Studies from different regions of India including Jammu, Kashmir, Chennai, Haryana, Delhi, Jabalpur, and Kerala estimated the utility of MDRF-IDRS in identifying risk for DM and prediabetes in Indian adult population and found statistically significant association between IDRS and DM patients indicating MDRF-IDRS to be efficient tool to screen and diagnose the huge pool of undiagnosed diabetics in India. [ 53 54 55 56 57 58 ]…”

Validity of madras diabetes research foundation: Indian diabetes risk score for screening of diabetes mellitus among adult population of urban field practice area, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

“…The score has been validated through many studies in various parts of the country,[ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] but extensive search on PubMed reveals no study from the state of Himachal Pradesh. Keeping this in view, the present study has been planned as the region-specific validation is important before it can be used for screening in this part of the country.…”