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Epidemiology/Health Services Research
Validity of the FINDRISC as a prediction tool for diabetes in a contemporary Norwegian population: a 10-year follow-up of the HUNT study
  1. Anne Jølle1,
  2. Kristian Midthjell1,
  3. Jostein Holmen1,
  4. Sven Magnus Carlsen2,3,
  5. Jaakko Tuomilehto4,5,6,
  6. Johan Håkon Bjørngaard7,
  7. Bjørn Olav Åsvold1,2,8
  1. 1HUNT Research Center, Department of Public Health and Nursing, NTNU, Levanger, Norway
  2. 2Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  3. 3Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
  4. 4Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
  5. 5Department of Public Health, University of Helsinki, Helsinki, Finland
  6. 6Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
  7. 7Department of Public Health and Nursing, NTNU, Trondheim, Norway
  8. 8K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Trondheim, Norway
  1. Correspondence to Professor Bjørn Olav Åsvold; asvold{at}ntnu.no

Abstract

Objective The Finnish Diabetes Risk Score (FINDRISC) is a recommended tool for type 2 diabetes prediction. There is a lack of studies examining the performance of the current 0–26 point FINDRISC scale. We examined the validity of FINDRISC in a contemporary Norwegian risk environment.

Research design and methods We followed 47 804 participants without known diabetes and aged ≥20 years in the HUNT3 survey (2006–2008) by linkage to information on glucose-lowering drug dispensing in the Norwegian Prescription Database (2004–2016). We estimated the C-statistic, sensitivity and specificity of FINDRISC as predictor of incident diabetes, as indicated by incident use of glucose-lowering drugs. We estimated the 10-year cumulative diabetes incidence by categories of FINDRISC.

Results The C-statistic (95% CI) of FINDRISC in predicting future diabetes was 0.77 (0.76 to 0.78). FINDRISC ≥15 (the conventional cut-off value) had a sensitivity of 38% and a specificity of 90%. The 10-year cumulative diabetes incidence (95% CI) was 4.0% (3.8% to 4.2%) in the entire study population, 13.5% (12.5% to 14.5%) for people with FINDRISC ≥15 and 2.8% (2.6% to 3.0%) for people with FINDRISC <15. Thus, FINDRISC ≥15 had a positive predictive value of 13.5% and a negative predictive value of 97.2% for diabetes within the next 10 years. To approach a similar sensitivity as in the study in which FINDRISC was developed, we would have to lower the cut-off value for elevated FINDRISC to ≥11. This would yield a sensitivity of 73%, specificity of 67%, positive predictive value of 7.7% and negative predictive value of 98.5%.

Conclusions The validity of FINDRISC and the risk of diabetes among people with FINDRISC ≥15 is substantially lower in the contemporary Norwegian population than assumed in official guidelines. To identify ~3/4 of those developing diabetes within the next 10 years, we would have to lower the threshold for elevated FINDRISC to ≥11, which would label ~1/3 of the entire adult population as having an elevated FINDRISC necessitating a glycemia assessment.

  • epidemiology
  • prediction and prevention

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000769

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    Footnotes

    • Contributors AJ and BOA designed the study and drafted the manuscript. KM, JH and JT contributed to data acquisition. BOA analyzed the data and supervised the study. All authors interpreted the results, critically reviewed the manuscript and approved the final version to be submitted.

    • Funding The study was funded by NTNU, Norwegian University of Science and Technology. BOA received support from the Research Council of Norway.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The study was approved by the Regional Committee for Medical and Health Research Ethics of Central Norway and by the Norwegian Data Protection Authority.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.