Indian Diabetes Risk Score helps to distinguish type 2 from non-type 2 diabetes mellitus (GDRC-3)

Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15)

Background & objectives

Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India.

Methods

Data were acquired from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS.

Results

We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions.

Interpretation & conclusions

Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.

Comparative Assessment of ADA, IDRS, and FINDRISC in Predicting Prediabetes and Diabetes Mellitus in South Indian Population

Introduction  Diabetes risk-screening tools are validated and implemented across various countries. There is a need for improvement in these risk scores with suitable modifications so as to make them more sensitive, specific, and suitable to the local population.

Objectives  The aim of this study was to evaluate and compare the diagnostic accuracy and clinical utility of the Indian diabetes risk score (IDRS), the American diabetic association (ADA) risk score, and the Finnish Diabetes Risk Score in healthy subjects of South Indian origin in predicting the risk of diabetes and to correlate these risk scores with the blood glucose and hemoglobin A1c (HbA1c) levels in the study population.

Materials and Methods  A total of 160 subjects attending the master health checkup/outpatient department of a tertiary care hospital were included in the study. Each subject was asked to fill a questionnaire. Details obtained using the questionnaire were assessed as per the three diabetic risk scores. Fasting blood sugar/random blood sugar and HbA1c were estimated.

Statistical Analysis Used  Data analysis was done using SPSS 22/23. Pearson correlation was used to compare continuous variables, with p < 0.05 considered statistically significant. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Mitchell’s clinical utility indices were calculated for each risk tool.

Results  We found the prevalence of diabetes to be 11.9%. ADA risk score was the only risk score that showed a statistically significant difference ( p -value = 0.05) between the low- and high-risk subjects.

Conclusions  ADA or IDRS risk scores can be used for screening diabetes in the South Indian population. We suggest that inclusion of the history of gestational diabetes and hypertension in the IDRS risk score might improve its sensitivity as a screening tool in our local population.

Management of Type II Diabetes by Modulating the Modifiable Risk Factors: A Future Roadmap for Prevention of Cerebrovascular Complications

Background:

Indian Diabetes Risk Score (IDRS) is a screening tool for quantifying the risk of diabetes mellitus (DM) development in the Indian population. The present study has evaluated the level of risk of developing DM in Chandigarh and Panchkula based on the IDRS score.

Methods:

As a part of a national diabetes control trial funded by the Ministry of Health and Family Welfare (MoHFW) and the Ministry of AYUSH, Government of India, 1,916 participants from the Chandigarh and Panchkula regions were assessed for the risk of developing DM. Risk assessment was done on the basis of the IDRS score which includes age, family history, waist circumference, and physical activity as its contributing factors. Participants with an IDRS score <30 were in the low-risk category, those with 30 to 50 were in the moderate-risk category, and those with >60 were in the high-risk category for DM.

Results:

Out of the 1,916 screened respondents (59.86% females and 40.14% males), 894 participants (46.65%) were at a high risk for DM (IDRS >60), 764 (39.87%) were at a moderate risk (IDRS = 30–60), and 258 (13.46%) were at a low risk (IDRS <30). Waist circumference contributed to 35.90% of the high-risk category followed by age (19.67%) and physical activity (11.67%). Age and waist circumference also showed a strong correlation with the total IDRS score.

Conclusion:

The Chandigarh and Panchkula population showed a high tendency to develop DM based on the IDRS score. Modifiable risk factors such as waist circumference and physical activity were the major contributing factors. Apart from the modifiable risk factors, age was also another major contributing risk factor. Based on these outcomes, lifestyle modifications like yoga and exercise can be proposed for this population as a preventive approach to reduce the risk of developing DM and other associated cerebrovascular complications.

Diabetes Risk among Medical Students in Tabuk City, Saudi Arabia

<b><i>Introduction:</i></b> Diabetes risk estimation is essential for the implementation of preventive measures. <b><i>Objectives:</i></b> We aimed to assess the diabetes risk among medical students in Tabuk, Saudi Arabia. <b><i>Methods:</i></b> This cross-sectional study was conducted among 169 medical students in the Medical College, University of Tabuk, Saudi Arabia, from October 2017 to April 2018. Participants signed a written informed consent and then responded to a questionnaire modified from the Finnish and the ARABRISK diabetes score. The questionnaire consisted of eight components inquiring about age, BMI, central adiposity, fruit and vegetable consumption, physical activity if found to have high blood pressure or blood sugar, and family history of diabetes mellitus. The Statistical Package for Social Sciences (SPSS) was used for data analysis. <b><i>Results:</i></b> Out of 169 students (68% with a family history of diabetes), obesity and overweight were found in 21.3 and 26.6%, respectively, 45.6% had central adiposity, more than half were not practicing exercise daily, and 60.4% were not consuming fruits and vegetables daily. A significant percentage was found to have high blood sugar (9.5%) and high blood pressure (4.7%). The diabetes risk score was high or moderate in 16% of the students. <b><i>Conclusion:</i></b> Medical students in Tabuk City were at high risk for diabetes mellitus. Obesity, overweight, central adiposity, physical inactivity, and less consumption of fruits and vegetables substantially contributed to the risk. Measures to prevent obesity, improving fruit and vegetable consumption, and exercise are needed.

Validation of simplified Indian Diabetes Risk Score for screening undiagnosed diabetes in an urban setting of Haryana

BACKGROUND AND OBJECTIVES

Identification of at risk individuals using simple screening tools like Indian Diabetes Risk Score (IDRS) and appropriate life style interventions could greatly help in preventing or delaying the onset of diabetes and thus reducing the burden of disease.

MATERIAL AND METHOD

450 individuals >20years who consented to participate were selected randomly from three anganwadis of urban area of Rohtak city. Demographic characteristics and anthropometric measurements such as weight, height and waist circumference were taken. BMI was calculated. IDRS developed by Mohan et al. was applied for categorizing the individuals as high risk, moderate risk and low risk. World Health Organization (WHO) criterion of fasting blood glucose ≥126mg/dl was used for diagnosing diabetes.

RESULTS

54% of individuals were categorized as high risk followed by 37.6% as moderate risk as per IDRS risk score. Prevalence of diabetes was more in ≥50years age group (28.6%) as compared to 35-49 years (14.2%) and 20-35 years age group (6.0%). Individuals with no physical activity had significantly high prevalence of diabetes as compared to mild or moderate physical activity (P 0.004). Similarly, males with waist circumference ≥100cm and females with ≥90cm had significantly high prevalence of diabetes (P 0.000 and P 0.005). On multiple logistic regression analysis age, family history of diabetes and BMI were independent predictors of diabetes.

CONCLUSION

Diabetes is a rising epidemic. Early screening and appropriate interventions at the start are needed for control of disease and risk factor modifications.

Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice

The Indian Diabetes Risk Score was initially developed by the Madras Diabetes Research Foundation (MDRF-IDRS) to help detect undiagnosed Type 2 diabetes (T2DM) in the community. Soon it was found that the MDRF-IDRS could also help to predict incident diabetes, metabolic syndrome, coronary artery disease (CAD), non-alcoholic fatty liver disease as well as sleep disorders in the community. It helps to differentiate T2DM from non-T2DM. Finally, it also helps to identify those with CAD, peripheral vascular disease and neuropathy among those with T2DM. Thus, the MDRF-IDRS is a simple, virtually 'no cost' tool which is useful in several clinical and epidemiological settings.