Development and validation of a Diabetes Risk Score for screening undiagnosed diabetes in Sri Lanka (SLDRISK)
Development and validation of a Diabetes Risk Score for screening undiagnosed diabetes in Sri Lanka (SLDRISK)
Background: screening for undiagnosed diabetes is not widely undertaken due to the high costs and invasiveness of blood sampling. Simple non-invasive tools to identify high risk individuals can facilitate screening. The main objectives of this study are to develop and validate a risk score for screening undiagnosed diabetes among Sri Lankan adults and to compare its performance with the Cambridge Risk Score (CRS), the Indian Diabetes Risk Score (IDRS) and three other Asian risk scores.
Methods: data were available from a representative sample of 4276 adults without diagnosed diabetes. In a jack-knife approach two thirds of the sample was used for the development of the risk score and the remainder for the validation. Age, waist circumference, BMI, hypertension, balanitis or vulvitis, family history of diabetes, gestational diabetes, physical activity and osmotic symptoms were significantly associated with undiagnosed diabetes (age most to osmotic symptoms least). Individual scores were generated for these factors using the beta coefficient values obtained in multiple logistic regression. A cut-off value of sum = 31 was determined by ROC curve analysis.
Results: the area under the ROC curve of the risk score for prevalent diabetes was 0.78 (CI 0.73–0.82). In the sample 36.3 % were above the cut-off of 31. A risk score above 31 gave a sensitivity, specificity, positive predictive value and negative predictive value of 77.9, 65.6, 9.4 and 98.3 % respectively. For Sri Lankans the AUC for the CRS and IDRS were 0.72 and 0.66 repectively.
Conclusions: this simple non-invasive screening tool can identify 80 % of undiagnosed diabetes by selecting 40 % of Sri Lankan adults for confirmatory blood investigations.
Diabetes, Risk score, Screening, South Asian, Sri Lanka
Katulanda, P.
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Hill, N.R.
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Stratton, I.
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Sheriff, R.
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De Silva, S.D.N.
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Matthews, D.R.
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25 July 2016
Katulanda, P.
c684e8e8-e69f-41d4-abdc-f2bf7a7ff776
Hill, N.R.
7b67945e-88c6-4e02-96cf-8c524d7cd8e2
Stratton, I.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Sheriff, R.
f8f761ea-f971-4571-84b4-f03868dd6c77
De Silva, S.D.N.
f62d6d29-e9c4-4862-aeee-7ff55cbb40a4
Matthews, D.R.
0ffdc149-9b44-4ba4-97ab-e9ddcbb206fd
Katulanda, P., Hill, N.R., Stratton, I., Sheriff, R., De Silva, S.D.N. and Matthews, D.R.
(2016)
Development and validation of a Diabetes Risk Score for screening undiagnosed diabetes in Sri Lanka (SLDRISK).
BMC Endocrine Disorders, 16 (1), [42].
(doi:10.1186/s12902-016-0124-8).
Abstract
Background: screening for undiagnosed diabetes is not widely undertaken due to the high costs and invasiveness of blood sampling. Simple non-invasive tools to identify high risk individuals can facilitate screening. The main objectives of this study are to develop and validate a risk score for screening undiagnosed diabetes among Sri Lankan adults and to compare its performance with the Cambridge Risk Score (CRS), the Indian Diabetes Risk Score (IDRS) and three other Asian risk scores.
Methods: data were available from a representative sample of 4276 adults without diagnosed diabetes. In a jack-knife approach two thirds of the sample was used for the development of the risk score and the remainder for the validation. Age, waist circumference, BMI, hypertension, balanitis or vulvitis, family history of diabetes, gestational diabetes, physical activity and osmotic symptoms were significantly associated with undiagnosed diabetes (age most to osmotic symptoms least). Individual scores were generated for these factors using the beta coefficient values obtained in multiple logistic regression. A cut-off value of sum = 31 was determined by ROC curve analysis.
Results: the area under the ROC curve of the risk score for prevalent diabetes was 0.78 (CI 0.73–0.82). In the sample 36.3 % were above the cut-off of 31. A risk score above 31 gave a sensitivity, specificity, positive predictive value and negative predictive value of 77.9, 65.6, 9.4 and 98.3 % respectively. For Sri Lankans the AUC for the CRS and IDRS were 0.72 and 0.66 repectively.
Conclusions: this simple non-invasive screening tool can identify 80 % of undiagnosed diabetes by selecting 40 % of Sri Lankan adults for confirmatory blood investigations.
Text
s12902-016-0124-8
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More information
Accepted/In Press date: 15 July 2016
Published date: 25 July 2016
Additional Information:
Funding Information: the National Science Foundation of Sri Lanka was the main source of funding for the SLDCS. Funding body did not interfere with design of the study, data collection, data interpretation or writning the manuscript.
Keywords:
Diabetes, Risk score, Screening, South Asian, Sri Lanka
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Local EPrints ID: 487125
URI: http://eprints.soton.ac.uk/id/eprint/487125
ISSN: 1472-6823
PURE UUID: b7394a67-ec1d-4ac1-be62-8f21df1f3640
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Date deposited: 14 Feb 2024 17:37
Last modified: 18 Mar 2024 04:01
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Contributors
Author:
P. Katulanda
Author:
N.R. Hill
Author:
I. Stratton
Author:
R. Sheriff
Author:
S.D.N. De Silva
Author:
D.R. Matthews
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