FINDRISC Modified for Latin America as a Screening Tool for Persons with Impaired Glucose Metabolism in Ciudad Bolívar, Venezuela

FINDRISC modified for Cuba as a tool for the detection of prediabetes and undiagnosed diabetes in cuban population

BACKGROUND

Motivation for the study. There is an increase in obesity and diabetes mellitus cases in Cuba, so it is necessary to provide easy to use, fast and inexpensive tools for the identification of people with dysglycemia. Main findings. For the first time in CUBA, the optimal cut-off point for FINDRISC, LA-FINDRISC and modified FINDRISC for Cuba (CUBDRISC) questionnaires was established with its own anthropometric parameters to identify people with dysglycemia. Implications. The use of the CUBDRISC scale as a simple, fast and low-cost tool for the active screening of people with dysglycemia in Cuban population will be useful to establish timely intervention strategies for people with risk score to develop dysglycemia.

OBJECTIVES.

To evaluate the Finnish Diabetes Risk Score (FINDRISC) modified for Cuba as a tool for the detection of prediabetes and undiagnosed diabetes in Cuban population.

MATERIALS AND METHODS.

An analytical cross-sectional and secondary source epidemiological study was conducted in 3737 adults aged 19 years and older with at least one risk factor for diabetes, they did not have previous diagnosis of prediabetes and diabetes mellitus and underwent oral glucose tolerance test for the diagnosis of dysglycemia. We applied the FINDRISC and the FINDRISC modified for Latin America (LA-FINDRISC) and Cuba (CUBDRISC), each with their own anthropometric parameters. The ROC curve was used to establish the cut-off point of each scale for the diagnosis of dysglycemia. Sensitivity, specificity, predictive values and likelihood ratios were calculated. The concordance between scales was calculated with Cohen's Kappa coefficient.

RESULTS.

We found that 34.5% (n=1289) of the subjects were diagnosed with dysglycemia (28.1% had prediabetes and 6.4% had type 2 diabetes without previous diagnosis). The LA-FINDRISC and CUBDRISC scales showed an almost perfect concordance with the FINDRISC scale for the different cut-off values from 11 to 16 (0.882-0.890 and 0.910-0.922, respectively). The optimal cutoff point for detecting persons with dysglycemia was ≥ 13 for the FINDRISC and CUBDRISC scales (sensitivity was 63.6% and 61.6%; specificity was 84.3% and 86.0%, respectively) and ≥11 for LA-FINDRISC (sensitivity 58.0% and specificity 88.0%).

CONCLUSIONS.

We found almost perfect concordance between the diabetes risk scales. The FINDRISC score modified for Cuba proved to be a useful tool to identify persons with prediabetes and diabetes with a cut-off point of 13 in a Cuban population.

Can social media encourage diabetes self-screenings? A randomized controlled trial with Indonesian Facebook users

Nudging individuals without obvious symptoms of non-communicable diseases (NCDs) to undergo a health screening remains a challenge, especially in middle-income countries, where NCD awareness is low but the incidence is high. We assess whether an awareness campaign implemented on Facebook can encourage individuals in Indonesia to undergo an online diabetes self-screening. We use Facebook's advertisement function to randomly distribute graphical ads related to the risk and consequences of diabetes. Depending on their risk score, participants receive a recommendation to undergo a professional screening. We were able to reach almost 300,000 individuals in only three weeks. More than 1400 individuals completed the screening, inducing costs of about US$0.75 per person. The two ads labeled "diabetes consequences" and "shock" outperform all other ads. A follow-up survey shows that many high-risk respondents have scheduled a professional screening. A cost-effectiveness analysis suggests that our campaign can diagnose an additional person with diabetes for about US$9.

Low muscle mass index is associated with type 2 diabetes risk in a Latin-American population: a cross-sectional study

Objective

Diabetes mellitus is a growing disease with severe complications. Various scores predict the risk of developing this pathology. The amount of muscle mass is associated with insulin resistance, yet there is no established evidence linking muscle mass with diabetes risk. This work aims to study that relationship.

Research methods and procedures

This cross-sectional study included 1,388 employees. The FINDRISC score was used to assess type 2 diabetes risk, and bioimpedance was used for body composition analysis. Appendicular skeletal muscle mass adjusted by body mass index (ASM/BMI) was analyzed. Sociodemographic, clinical and anthropometric measures were evaluated, logistic regression models with sex stratification were conducted and ROC curves were calculated to determine the ability of ASM/BMI index to predict T2D risk.

Results

It was observed that patients with higher ASM/BMI had a lower FINDRISC score in both men and women (p < 0.001). A logistic regression model showed and association between ASM/BMI and diabetes risk in women [OR: 0.000 (0.000-0.900), p = 0.048], but not in men [OR: 0.267 (0.038-1.878), p = 0.185]. However, when the body mass index variable was excluded from the model, an association was found between muscle mass adjusted to BMI and diabetes risk in both men [OR: 0.000 (0.000-0.016), p < 0.001], and women [OR:0.001 (0.000-0.034), p < 0.001]. Other risk factors were having a low level of physical activity, waist circumference, age and sedentary lifestyle. A ROC curve was built and the optimal ASM/BMI cut-of value for predicting T2D risk was 0.82 with a sensitivity of 53.71% and specificity of 69.3% [AUC of 0.665 (0.64-0.69; p < 0.0001)].

Conclusion

When quantifying the risk of type 2 diabetes in both women and men, assessing muscle mass can help detect adult individuals with a high risk of developing type 2 diabetes.

Common risk factors for dental caries and impaired glucose regulation in Guangxi, China

OBJECTIVES

To assess the prevalence of caries and impaired glucose regulation (IGR) and try to investigate their common risk factors among adult residents in Guangxi province.

METHODS

A cross-sectional study was conducted on a sample of 2993 adults from five different areas of Guangxi province. The sociodemographic data, history of personal habits such as diet and physical activities, physical measurements, oral examination results and biochemical laboratory test data were collected to establish a database and prepare a sound research model. Chi-square test and multiple logistic regression were used to analyse the risk factors for dental caries and IGR.

RESULTS

The prevalence rate for caries was 85.9%, and the mean DMFT score was 7.35. In multiple logistic regression, after adjustment, education level, occupation, daily consumption of vegetables, weekly consumption of carbonated beverages and weekly exercise were associated with caries (odds ratio [OR]: 2.10, OR: 1.80, OR: 1.40, OR: 2.45, OR: 2.38). The prevalence of IGR was 33.5%, and after adjustment, results showed that occupation, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, high-density lipoprotein-C levels and low-density lipoprotein-C levels were significantly associated with IGR (OR: 0.80, OR: 1.70, OR: 1.56, OR: 1.88, OR: 1.60, OR: 1.43, OR: 1.48). The strength of association between caries/IGR and risk factors was a weak association or moderate association.

CONCLUSIONS

We have not found common risk factors between dental caries and IGR. Therefore, further studies are needed to explore these common risk factors to prevent caries and IGR.

ModAsian FINDRISC as a Screening Tool for People with Undiagnosed Type 2 Diabetes Mellitus in Vietnam: A Community-Based Cross-Sectional Study

Purpose

Our study aims to evaluate the risk of developing type 2 diabetes mellitus in the next 10 years using ModAsian FINDRISC and additionally explore associated factors among the Vietnam population.

Participants and Methods

A cross-sectional study was conducted on 2258 participants aged 25 years old or above in Thua Thien Hue Province, Vietnam. The sample size is calculated based on the estimated sensitivity, and participants were randomly selected from different geographical and socio-economic areas. All participants were thoroughly medically examined, taking blood lipid profile and fasting blood glucose, taking blood pressure, anthropometric indexes, 12-lead electrocardiogram, and behavioral factors were investigated using the Vietnamese version of the WHO STEPS toolkit. The risk of developing T2DM was made based on the ModAsian FINDRISC.

Results

The incidence of developing type 2 diabetes mellitus among the study population was 4.21%. The group with a high or very high risk of developing type 2 diabetes mellitus in the next 10 years accounted for 2.52%. Body mass index (AUC = 0.840, 95% CI: 0.792-0.888), waist circumference (AUC = 0.824, 95% CI: 0.777-0.871), family history of diabetes mellitus (AUC = 0.751, 95% CI = 0.668-0.833), and history of antihypertensive medication use regularly (AUC = 0.708, 95% CI: 0.632-0.784) are the most associated factors of the ModAsian FINDRISC. Residential location (OR = 5.62, 95% CI: 1.91-16.54) and occupational status (OR = 0.35, 95% CI: 0.20-0.62) were significant factors associated with a high and very high risk of developing type 2 diabetes mellitus in the next 10 year.

Conclusion

Screening for the risk of type 2 diabetes mellitus and implementing intervention programs focusing on controlling weight, waist circumference, and blood pressure are essential for reducing type 2 diabetes mellitus incidence and burden in Vietnam.

Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial

AIM

To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA).

MATERIAL AND METHODS

A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome.

RESULTS

From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001).

CONCLUSIONS

The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

FINDRISC in Latin America: a systematic review of diagnosis and prognosis models

This review aimed to assess whether the FINDRISC, a risk score for type 2 diabetes mellitus (T2DM), has been externally validated in Latin America and the Caribbean (LAC). We conducted a systematic review following the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) framework. Reports were included if they validated or re-estimated the FINDRISC in population-based samples, health facilities or administrative data. Reports were excluded if they only studied patients or at-risk individuals. The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. Risk of bias was assessed with the PROBAST (Prediction model Risk of Bias ASsessment Tool) tool. From 1582 titles and abstracts, 4 (n=7502) reports were included for qualitative summary. All reports were from South America; there were slightly more women, and the mean age ranged from 29.5 to 49.7 years. Undiagnosed T2DM prevalence ranged from 2.6% to 5.1%. None of the studies conducted an independent external validation of the FINDRISC; conversely, they used the same (or very similar) predictors to fit a new model. None of the studies reported calibration metrics. The area under the receiver operating curve was consistently above 65.0%. All studies had high risk of bias. There has not been any external validation of the FINDRISC model in LAC. Selected reports re-estimated the FINDRISC, although they have several methodological limitations. There is a need for big data to develop-or improve-T2DM diagnostic and prognostic models in LAC. This could benefit T2DM screening and early diagnosis.

Risk scores for type 2 diabetes mellitus in Latin America: a systematic review of population-based studies

AIM

To summarize the evidence on diabetes risk scores for Latin American populations.

METHODS

A systematic review was conducted (CRD42019122306) looking for diagnostic and prognostic models for type 2 diabetes mellitus among randomly selected adults in Latin America. Five databases (LILACS, Scopus, MEDLINE, Embase and Global Health) were searched. type 2 diabetes mellitus was defined using at least one blood biomarker and the reports needed to include information on the development and/or validation of a multivariable regression model. Risk of bias was assessed using the PROBAST guidelines.

RESULTS

Of the 1500 reports identified, 11 were studied in detail and five were included in the qualitative analysis. Two reports were from Mexico, two from Peru and one from Brazil. The number of diabetes cases varied from 48 to 207 in the derivations models, and between 29 and 582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was ~ 70% (range: 66-72%) as per the area under the receiving-operator curve, the highest metric was always the negative predictive value. Sensitivity was always higher than specificity.

CONCLUSION

There is no evidence to support the use of one risk score throughout Latin America. The development, validation and implementation of risk scores should be a research and public health priority in Latin America to improve type 2 diabetes mellitus screening and prevention.