Abstract
BackgroundTo investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria.MethodsA cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).ResultsDefining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.ConclusionsA shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy.
Highlights
To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria
A two-step procedure could be used: first, patients would be screened with a risk score; and second, those individuals identified to have a high risk for diabetes, would have their glycemic status assessed by measuring fasting plasma glucose (FPG), either alone or along with 2-hour post-load glucose (2hPG) using the oral glucose tolerance test (OGTT), or the more recently authorized hemoglobin (Hb)A1c measurement [2,3,4]
In a previous work conducted in the same population, we showed that defining diabetes by FPG resulted in a significant decrease in prevalence compared with defining diabetes by 2hPG, even in repeat tests for those participants who agreed to the lifestyle intervention [26]
Summary
To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria. It has recently been suggested that progression to diabetes can be delayed by intensive intervention when applied to real-life primary health care of high-risk subjects identified first with the simple Finnish Diabetes Risk Score (FINDRISC) tool [7]. If such a risk score can be shown to have general applicability, it could provide a rational basis to decide which patients might benefit from intensive lifestyle intervention [8]. Community-based evaluations are essential in order to learn about the FINDRISC feasibility and performance to screen for current and future glucose disorders
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