Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy

BMC Medicine

Oriol Solà-Morales¹  Jordi Salas-Salvadó²  Ramon Sagarra³  Xavier Mundet³  Joan J Cabré³  Josep L Piñol³  Francisco Barrio³  Bernardo Costa³ 

[1]Pere Virgili Health Research Institute. Health Institute Technology Transfer, Tarragona-Barcelona, Sant Llorenç 21, 43201, Reus, Spain

[2]CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain

[3]Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202, Reus, Spain

关键词: primary healthcare;    FINDRISC;    pre-diabetes;    impaired glucose tolerance;    impaired fasting glucose;    screening;    Type 2 diabetes;   

Others  :  857182
DOI  :  10.1186/1741-7015-11-45

 received in 2012-09-12, accepted in 2013-02-21,  发布年份 2013

【 摘 要 】

Background

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.

Methods

A 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).

Results

Defining 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.

Conclusions

A 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.

【 授权许可】

   
2013 Costa et al; licensee BioMed Central Ltd.

【 图 表 】

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