A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

Marta Guasch-Ferré,Ramon Estruch,Francisco Barrio,Bernardo Costa,Mònica Bulló,Jordi Salas-Salvadó,Miguel Ángel Martínez-Gonzalez,For The Predi-Plan Investigators ,Núria Ibarrola-Jurado

doi:10.1371/journal.pone.0033437

Abstract

IntroductionTo develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk.Materials and MethodsA diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC).ResultsThe PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples.DiscussionWe identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

Highlights

To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk
We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk
The present study shows that the PREDIMED-clinical score had good sensitivity, specificity and negative predictive value but lower positive predictive value for identifying those elderly individuals at high risk of developing diabetes in Spanish population at high cardiovascular risk; and had a higher predictive ability than other common diabetes risk scores used in clinical settings

Summary

Introduction

To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. The increase in the prevalence of T2DM across the world has become an important public health problem given that it ranks among the leading causes of blindness, renal failure lower limb amputation, and is a significant risk factor for coronary heart disease and stroke, increasing mortality [3] and increasing human and financial public health costs [4]. Strong evidence from several studies has demonstrated that T2DM could be prevented by diet and other lifestyle modifications in high-risk individuals (reviewed by [5]) [6,7]. It is important the earlier detection of individuals at high risk for diabetes to lead to this target population the intensive preventive interventions [8,9]

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