Abstract
This was a cross-sectional study designed to assess the validity of the Finnish Diabetes Risk Score for detecting undiagnosed type 2 diabetes among general medical outpatients in Botswana. Participants aged ≥20 years without previously diagnosed diabetes were screened by (1) an 8-item Finnish diabetes risk assessment questionnaire and (2) Haemoglobin A1c test. Data from 291 participants were analyzed (74.2% were females). The mean age of the participants was 50.1 (SD = ±11) years, and the prevalence of undiagnosed diabetes was 42 (14.4%) with no significant differences between the gender (20% versus 12.5%, P = 0.26). The area under curve for detecting undiagnosed diabetes was 0.63 (95% CI 0.55–0.72) for the total population, 0.65 (95% CI: 0.56–0.75) for women, and 0.67 (95% CI: 0.52–0.83) for men. The optimal cut-off point for detecting undiagnosed diabetes was 17 (sensitivity = 48% and specificity = 73%) for the total population, 17 (sensitivity = 56% and specificity = 66%) for females, and 13 (sensitivity = 53% and specificity = 77%) for males. The positive predictive value and negative predictive value were 20% and 89.5%, respectively. The findings indicate that the Finnish questionnaire was only modestly effective in predicting undiagnosed diabetes among outpatients in Botswana.
Highlights
Type 2 diabetes mellitus (T2D) is a common chronic disease globally, and its long-term sequelae include microvascular and macrovascular complications [1]
Low-income countries, including those in Sub-Saharan Africa (SSA) are projected to have the largest proportional increase in the burden of T2D among adults compared to developed countries by the year 2030 [3]
In both communities in SSA, the current decline in communicable diseases like human immunodeficiency virus (HIV)/AIDS, tuberculosis, and malaria has been associated with an increase in life expectancy in the general population leading to the rise of T2D epidemic [7]
Summary
Type 2 diabetes mellitus (T2D) is a common chronic disease globally, and its long-term sequelae include microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (stroke and myocardial infarctions) complications [1]. Most cross-sectional studies in SSA report higher burden of T2D in the urban communities compared to rural settings [4, 5]. This may be attributed to the increasing urbanization and socioeconomic development in the region. Urban settings may lead to sedentary lifestyles and unhealthy diets and related obesity, hypertension, dyslipidaemia, and T2D [6] In both communities in SSA, the current decline in communicable diseases like HIV/AIDS, tuberculosis, and malaria has been associated with an increase in life expectancy in the general population leading to the rise of T2D epidemic [7]. Over 50% of cases may be unaware or undiagnosed in SSA including Botswana due to underresourced healthcare systems often resulting in late diagnosis and poor outcomes [8]
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