New screening tool may help identify patients with prediabetes

TAG-IT demonstrated utility in younger populations and represented improvement vs. assessing BMI alone.

Researchers have developed a new clinical tool to assess the likelihood of impaired fasting glucose to identify individuals with prediabetes and undiagnosed diabetes.

Tool to Assess Likelihood of Fasting Glucose Impairment (TAG-IT) uses six self-reported risk factors: age, sex, BMI, family history, resting heart rate and hypertension.

“The goal was to create a score that would transform a list of risk factors into a number that could help physicians make the decision of when to screen,” Richelle J. Koopman, MD, MS, assistant professor of family medicine in the department of family and community medicine at the University of Missouri, told Endocrine Today.

The tool has been validated using National Health and Nutrition Examination Survey data, examined in race and ethnicity subsets and compared with use of other self-reported risk factors, such as BMI alone, according to the researchers.

Koopman and colleagues at Medical University of South Carolina conducted a cross-sectional analysis of NHANES 1999-2004 data, which included 4,045 U.S. adults aged 20 to 64 years. At the start of the analysis, no individual had been previously diagnosed with diabetes.

Combining predictors of age, sex, BMI, family history, resting heart rate and hypertension yielded an area under the curve of 0.740, according to the results published in Annals of Family Medicine.

“Compared with BMI alone [AUC=0.644], TAG-IT had better predictive ability,” Koopman said. In addition, TAG-IT was validated in younger age groups, she said.

“TAG-IT efficiently identifies those most likely to have abnormal fasting glucose and can be used as a decision aid for screening in clinic and population settings or as a prescreening tool to help identify potential participants for research,” the researchers wrote.

“Once we detect impaired fasting glucose, we know from studies like the Diabetes Prevention Program that we can prevent diabetes, and this tool can hopefully alter people’s risk perception, raise awareness and propel them toward positive lifestyle changes,” Koopman said. – by Katie Kalvaitis

Ann Fam Med. 2008;6:555-561.

Although TAG-IT is better than assessing BMI alone, it is probably inferior to the height/waist circumference ratio or even waist circumference as a predictor of abnormal fasting glucose. Although it may be helpful in identifying patients for clinical trials, it is unwieldy and unlikely to be used in clinical practice.

– David S. H. Bell, MD

Endocrine Today Editorial Board member