A Simplified Finnish Diabetes Risk Score to Predict Type 2 Diabetes Risk and Disease Evolution in a German Population

Abstract

Aims: The FINDRISC questionnaire is a screening tool to estimate the risks for type 2 diabetes as well as asymptomatic type 2 diabetes. We aimed to evaluate its performance to predict diabetes in a German population and to compare its predictive and detective ability in the same population.

Methods: A total of 552 subjects with increased risk of type 2 diabetes were investigated. All individuals completed the FINDRISC questionnaires and underwent an oral glucose tolerance test (OGTT). All individuals were followed for 3 years and underwent an OGTT again. The performance of the opportunistic screening was assessed with the area under the receiver operating characteristics curve (AUC). An intervention program was carried out for all diabetic and IFG/IGT patients at baseline.

Results: For identification, the asymptomatic type 2 DM was named Condition 1; prediction of type 2 DM risk in the follow-up survey as Condition 2; and diabetes risk predicting in a hypothetical case of survey without intervention program as Condition 3. The ROC-AUC in the three condition were AUC_FINDRISC1=0.745, AUC_FINDRISC2=0.789, and AUC_FINDRISC3=0.775, respectively. A significant association between FINDRISC and evolution of disease was found, but the variation of plasma glucose during the three years follow-up was not associated with FINDRISC. People in the intervention group with an improvement of glucose tolerance had a smaller FINDRISC score than persons with an unchanged or progressive condition of disease.

Conclusion: FINDRISC was validated in our study as a simple tool with high performance to predict diabetes risk and less efficient to identify asymptomatic type 2 diabetes. People with lower FINDRISC score will benefit easier from preventive intervention.

Key words

Diabetes risk score - predicting of diabetes risk

References

• 1 Drewes T. et al . Estrogen-inducible derivatives of hepatocyte nuclear factor-4, hepatocyte nuclear factor-3 and liver factor B1 are differently affected by pure and partial antiestrogens.  Eur J Biochem. 1994;  225 441-448
• 2 Linnemann B. et al . C-reactive protein is a strong independent predictor of death in type 2 diabetes: association with multiple facets of the metabolic syndrome.  Exp Clin Endocrinol Diabetes. 2006;  114 ((3)) 127-134
• 3 Valensi P. et al . Pre-diabetes essential action: a European perspective.  Diabetes Metab. 2005;  31 606-620
• 4 Knowler WC. et al . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 393-403
• 5 Pan XR. et al . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.  Diabetes Care. 1997;  20 537-544
• 6 Tuomilehto J. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
• 7 Chiasson JL. et al . Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.  Lancet. 2002;  359 2072-2077
• 8 Torgerson JS. et al . XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.  Diabetes Care. 2004;  27 155-161
• 9 Wenying Y. et al . The preventive effect of acarbose and metformin on the IGT population from becoming diabetes mellitus: a 3-year multicenter prospective study.  Chin J Endocrinol Metab. 2001;  17 131-136
• 10 Schwarz PE. et al . Development of a diabetes prevention management program for clinical practice.  Public Health Rep. 2007;  122 258-263
• 11 Schwarz PE. et al . Diabetes prevention - from physiology to implementation.  Horm Metab Res. 2006;  38 460-464
• 12 Simons WR. et al . Does rapid transition to insulin therapy in subjects with newly diagnosed type 2 diabetes mellitus benefit glycaemic control and diabetes-related complications? A German population-based study.  Exp Clin Endocrinol Diabetes. 2006;  114 ((9)) 520-526
• 13 Schwarz PE, Bornstein SR. Pre-diabetes and metabolic syndrome in Germans.  Horm Metab Res. 2006;  38 359
• 14 Schwarz PE, Bornstein SR, Hanefeld M. Elevated fasting glucose levels predicts IGT and diabetes also in middle-age subjects.  Diabetes Res Clin Pract. 2007;  77 148-150
• 15 Schwarz PE. Congress report from the American diabetes association 66th annual scientific sessions in Washington, USA.  Exp Clin Endocrinol Diabetes. 2006;  114 ((10)) 605-610
• 16 Lindstrom J, Tuomilehto J. The Diabetes Risk Score: A practical tool to predict type 2 diabetes risk.  Diabetes Care. 2003;  26 725-731
• 17 Saaristo T. et al . Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome.  Diab Vasc Dis Res. 2005;  2 67-72
• 18 Olckers A. et al . Protective effect against type 2 diabetes mellitus identified within the ACDC gene in a black South African diabetic cohort.  Metabolism. 2007;  56 587-592
• 19 Schwarz PE. et al . Hypoadiponectinemia is associated with progression toward type 2 diabetes and genetic variation in the ADIPOQ gene promoter.  Diabetes Care. 2006;  29 1645-1650
• 20 Thamer C. et al . Beta cell function, insulin resistance and plasma adiponectin concentrations are predictors for the change of postprandial glucose in non-diabetic subjects at risk for type 2 diabetes.  Horm Metab Res. 2006;  38 178-182
• 21 Gouni-Berthold I. et al . The K121Q polymorphism of the plasma cell glycoprotein-1 gene is not associated with diabetes mellitus type 2 in German Caucasians.  Horm Metab Res. 2006;  38 524-529
• 22 Fisher E. et al . Preliminary evidence of FABP2 A54 T polymorphism associated with reduced risk of type 2 diabetes and obesity in women from a German cohort.  Horm Metab Res. 2006;  38 341-345
• 23 Haslbeck KM. et al . The AGE/RANGE/NF-(kappa)B pathway may contribute to the pathogenesis of polyneuropathy in impaired glucose tolerance (IGT).  Exp Clin Endocrinol Diabetes. 2005;  113 ((5)) 288-291
• 24 Uhlmann K. et al . Genetics of diabetic retinopathy.  Exp Clin Endocrinol Diabetes. 2006;  114 ((6)) 275-294
• 25 Schwarz P. High risk strategy in diabetes prevention - pro.  Dtsch Med Wochenschr. 2005;  130 1103
• 26 Schwarz PE. et al . Haplotypes in the promoter region of the ADIPOQ gene are associated with increased diabetes risk in a German caucasian population.  Horm Metab Res. 2006;  38 447-451
• 27 Parhofer KG. Beyond LDL-cholesterol: HDL-cholesterol as a target for atherosclerosis prevention.  Exp Clin Diabetes. 2005;  113 ((8)) 414-417
• 28 World Health Organization .Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation 1999
• 29 Schuppenies A. et al . FINDRISK: Finde das Risiko! - Entwicklung eines Fragebogens zur Einschätzung des Diabetesrisikos.  Ernährungs-Umschau. 2006;  53 386-389
• 30 Kubaszek A. et al . Promoter polymorphisms of the TNF-alpha (G-308A) and IL-6 (C-174G) genes predict the conversion from impaired glucose tolerance to type 2 diabetes: the Finnish Diabetes Prevention Study.  Diabetes. 2003;  52 1872-1876
• 31 Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine.  Clin Chem. 1993;  39 561-577
• 32 Hanley JA, MacNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases.  Radiology. 1983;  148 839-843
• 33 Wenying Y. et al . The preventive effect of acarbose and metformin on the progression to diabetes mellitus in the IGT population: a 3-year multicenter prospective study.  Chin J Endocrinol Metab. 2001;  17 131-136
• 34 Schwarz PE. et al . Prevention of type 2 diabetes: what challenges do we have to address?.  J Pub Health. 2005;  13 296-303
• 35 Schwarz PE. et al . Prevention of diabetes mellitus: The future of German diabetology.  Hamostaseologie. 2007;  27 13-21
• 36 Franciosi M. et al . Use of the diabetes risk score for opportunistic screening of undiagnosed diabetes and impaired glucose tolerance: the IGLOO (Impaired Glucose Tolerance and Long-Term Outcomes Observational) study.  Diabetes care. 2005;  28 1187-1194
• 37 Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test?.  Ann Int Med. 2002;  136 575-581
• 38 Kanaya AM. et al . Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule.  Diabetes Care. 2005;  28 404-408
• 39 Schulze MB. et al . An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes.  Diabetes Care. 2007;  30 510-515
• 40 Schwarz PEH. et al . An accurate risk score based on anthropometric, dietary, and lifestyle factors prediet the development of type 2 diabetes, response to schulze et al.  Diabetes care. 2007;  30 ((8)) e87
• 41 Hanefeld M. et al . The metabolic syndrome - a postprandial disease?.  Horm Metab Res. 2006;  38 435-436

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