Evaluation of the Finnish Diabetes Risk Score as a screening tool for impaired fasting glucose, impaired glucose tolerance and undetected diabetes
Introduction
According to current estimates by the International Diabetes Federation (IDF), diabetes affects more than 285 million people worldwide, and the number of people with diabetes is expected to increase dramatically to more than 380 million by 2025, thus fast becoming the epidemic of the 21st century [1]. Type 2 diabetes mellitus is one of the most common causes of adult blindness, end-stage kidney disease, nontraumatic amputation and cardiovascular disease (CVD); in addition, patients with type 2 diabetes have a reduced lifespan. The rapidly increasing prevalence of the disease is largely driven by lifestyle factors including changes in dietary patterns and habits, declining levels of physical activity and increasing sedentary behaviors [2], [3].
Individuals with prediabetes – a cumulative term for two intermediate conditions – impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), morbid obesity, history of gestational diabetes mellitus, family history of diabetes and multiple CVD risk factors have the greatest risk of developing type 2 diabetes [4], [5], [6], [7]. The annualized relative risk of a person with IGT progressing to diabetes is increased 6-fold compared with people with normal glucose tolerance; the annualized relative risk of people with isolated IFG progressing to diabetes showing a 4.7-fold increase [8].
There is clearly growing evidence that earlier detection of people with prediabetes and others at high risk, followed by interventions to delay or prevent type 2 diabetes and improve glucose control, can result in clinically important reductions in the incidence of diabetes and its complications and co-morbidities [9], [10], [11], [12], [13]. Simple, practical, non-invasive and inexpensive methods are needed to identify individuals at high risk for diabetes and to limit the proportion of the population requiring diagnostic glucose tolerance tests. Both IDF and European Evidence-Based Guidelines for the Prevention of Type 2 Diabetes recommend the use of brief questionnaires to help health-care professionals to quickly identify people who may be at higher risk and who need to have their level of risk further investigated [9], [14], [15]. A number of questionnaires and informative scoring systems have been developed to characterize individuals according to their future risk of type 2 diabetes [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26].
The Finnish Diabetes Risk Score (FINDRISC) was developed in 2001 based on a highly representative random sample of the Finnish population [24]. It is a product of the Finnish National Diabetes Programme (DEHKO 2001–2010) coordinated by the Finnish Diabetes Association and designed and scientifically validated by the National Public Health Institute, Helsinki, Finland [27]. With only 8 scored questions about variables clearly correlated with the risk of developing diabetes: age; body mass index; family history of diabetes; waist circumference; use of anti-hypertensive medication; history of elevated blood glucose; meeting the criterion for daily physical activity and daily consumption of fruit and vegetables, it provides a measure of the probability of developing type 2 diabetes over the following 10 years. It appears to be an example of an effective patient questionnaire and has been recommended to be used as the basis for developing national questionnaires [9], [14], [15]. FINDRISC has been tested in different countries till now as part of the EU-funded DE-PLAN Project (Diabetes in Europe – prevention using lifestyle, physical activity and nutritional intervention) [28], [29], [30], [31], [32]. Therefore the aim of the present study was to evaluate the performance of FINDRISC as a screening tool in detecting asymptomatic prediabetes – impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and undetected diabetes (UDD) in a representative sample of high-risk Bulgarian population in a cross-sectional setting.
Section snippets
Subjects
2169 subjects (879 males and 1290 females), of mean age 50.3 ± 14.4 years and mean BMI 29.6 ± 6.1 kg/m2, having at least one of the main risk factors for diabetes (a first degree relative with type 2 diabetes; overweight or central obesity; history of gestational diabetes; delivery of a baby over 4 kg; history of IFG or IGT, arterial hypertension; lipid abnormalities; clinically established atherosclerotic vascular disease) were enrolled in a cross-sectional survey. They were recruited by referrals
Results
56.6% (n = 1227) of subjects demonstrated normal glucose tolerance (NGT), 14.5% (n = 315) – IFG, 11.4% (n = 247) – IGT and 17.5% (n = 380) – newly diagnosed diabetes (Table 1). NGT group demonstrated mean FINDRISC 10.1 ± 3.4, IFG group – 13.8 ± 4.3 (p < 0.0001 vs. NGT), IGT group – 14.4 ± 5.4 (p < 0.0001 vs. NGT) and newly diagnosed diabetes group – 15.5 ± 4.8 (p < 0.0001 vs. NGT and IFG, p < 0.01 vs. IGT) (Fig. 1). FINDRISC appeared to be higher in females as compared to males in all groups – 10.31 ± 3.97 vs. 9.79 ± 3.74
Discussion
It is well-known that 30–60% of individuals with diabetes in the community are undiagnosed [1] and that undiagnosed diabetes is associated with increased mortality and risk of cardiovascular disease [34], [35]. Early identification of subjects with diabetes and prevention of the global epidemic of type 2 diabetes mellitus appear to be of paramount importance. The major challenge is the identification of individuals from the overall population who may be at higher than average risk of developing
Conclusions
FINDRISC appears to be a feasible, non-invasive and useful tool for identifying subjects at risk for undetected diabetes and prediabetes. On the basis of the present results we may conclude that laboratory screening for both prediabetes and diabetes should be performed in subjects with a FINDRISC higher than 10.
Conflict of interest
There are no conflicts of interest.
Acknowledgement
This study was supported by a grant (308/2007) of the Ministry of Education and Science, Bulgaria.
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