Abstract
Diabetes has been recognized as a “global health emergency” with an estimated 9% of adults being affected. However, about half of these adults remain undiagnosed. Conventional screening tools like fasting plasma glucose (FPG), oral glucose tolerance testing (OGTT) and glycosylated haemoglobin (HbA1c) can be inconvenient and expensive in a community-based setting. The Indian Diabetes Risk Score (IDRS) is a simple, non-invasive tool which has been validated for use in the Indian population. Age, abdominal obesity, family history of diabetes and physical activity levels have been weighted for a maximum score of 100. Persons with IDRS of <30 are categorized as low risk, 30-50 as medium risk and those with > 60 as high risk for diabetes. A community based, cross-sectional, analytical study was planned to assess the performance of IDRS among adults in a semi-urban area in Kathmandu, Nepal. A total of 256 (170 female, 86 male) persons without diabetes from 260 households were screened during the study period. A majority (46.09%) were classified as high risk, 44.53% as moderate risk and 9.38% as low risk for developing diabetes. Among them, 162 (63.28%) volunteered for definitive testing. The prevalence of undiagnosed diabetes and prediabetes was 4.32% (95% CI: 1.75% to 8.70%) and 7.14% (95% CI: 3.89% to 12.58%) respectively. IDRS predicted the combined risk of diabetes and prediabetes with sensitivity of 84.21% and specificity of 55.24% in adults with score of 60 and above. The area under the ROC curve (AUC) of IDRS for identifying diabetes and prediabetes was 0.69 as compared to the gold standard (2hour Plasma Glucose) AUC of 0.98. IDRS may be a suitable screening tool for diabetes and prediabetes in the adult Nepalese study population.
Highlights
Diabetes has been recognized as “one of the largest global health emergencies of the 21st century”.1 Type 2 diabetes (T2D) accounts for up to 90% of diabetes worldwide.[2]Globally, 9% of adults are estimated to have diabetes, with 1 in 2 adults being undiagnosed
For assessing the performance of Indian Diabetes Risk Score (IDRS), all of the study participants who were not previously diagnosed with diabetes were invited for an oral glucose tolerance test (OGTT) (WHO 1998 criteria) for definitive testing
Step 1: Adults over 20 years of age who were present in the household and not pregnant at the time of the survey were interviewed using a pretested structured questionnaire and IDRS screening tool after obtaining due written consent by trained UG medical students supervised by faculty from the department of Community Medicine.[13]
Summary
9% of adults are estimated to have diabetes, with 1 in 2 adults being undiagnosed. Up to 80% of individuals with undiagnosed diabetes are believed to live in low and middle income countries.[3]. The natural history of T2D includes a preceding period of impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).[4] Prediabetes (IFG and IGT) refers to this stage between normal blood glucose levels and diabetes. They represent persons who are at risk of developing diabetes mellitus in the future.[5]
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