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Screening tool may underestimate diabetes risk by sex, age
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The widely used Finnish Diabetes Risk Score does not fully capture the impact of age and sex on diabetes risk in Norwegian adults, recent study findings show.
The eight-item questionnaire, known as FINDRISC, includes age; BMI; waist circumference; physical activity; daily consumption of fruits, berries and vegetables; history of antihypertensive drug treatment; blood glucose history; and family history of diabetes. The items are weighed into a total score ranging from 0 to 26; in an original Finnish study population, a score of 15 or greater was associated with high risk for developing type 2 diabetes within 10 years.
Anne Jølle
“FINDRISC has been evaluated in several studies in Europe and other regions and is shown to be a reliable predictor for future diabetes in most of these studies,” Anne Jølle, MD, a specialist in family medicine and research fellow in the department of public health and general practice at the Norwegian University of Science and Technology, and colleagues wrote. “Few of these studies have been population-based. Consequently, little is known about the prevalence of elevated FINDRISC [score] in the general population and by age or sex. ... Such information is essential in order to evaluate the extent of health care needed for follow-up of high-risk individuals if FINDRISC is incorporated as a screening tool at the population level.”
Jølle and colleagues estimated the prevalence of an elevated FINDRISC score ( 15) among 47,694 adults participating in the third Nord-Trøndelag Health Study (HUNT3; 2006-2008). Researchers also estimated the positive predictive value of an elevated FINDRISC score for identifying unknown diabetes or impaired glucose metabolism among 2,559 participants who underwent an oral glucose tolerance test.
The overall prevalence of an elevated FINDRISC score was 11%, with the prevalence increasing with age and higher among women vs. men (12.1% in women vs. 9.6% in men). Overall, scores were 17 times higher at age 70 to 79 years (24.9%) vs. age 20 to 39 years (1.5%).
Among the 2,559 participants who underwent an OGTT, positive predictive values of elevated FINDRISC scores were 9.8% for diabetes, 16.9% for impaired glucose tolerance, 8.2% for impaired fasting glucose and 34.9% for any form of impaired glucose metabolism.
Researchers found that the positive predictive value for impaired glucose metabolism was lower in women vs. men in this group (31.2% vs. 40.4%), and increased “strongly and continuously” with age overall, from 19.1% at age 20 to 39 years to 55.5% at age 80 years and older.
“Sex may need to be included as a risk factor in the FINDRISC questionnaire, or the cutoff value for elevated FINDRISC for men and women should be differentiated,” Jølle told Endocrine Today. “This is essential information if FINDRISC is to be incorporated as a screening tool on a population level.”
The study findings suggest that the FINDRISC score components may be underestimated in men relative to women, Jølle said, and that a cutoff point of 15 does not imply the same diabetes risk in both sexes.
“Clinicians, in general, and myself as a family doctor, when we use FINDRISC as a screening tool or if patients present their self-screening to us, we should be more eager to do laboratory measurements on men with a FINDRISC [score] just under the threshold of 15,” Jølle said. “This is especially important since several studies in western Europe, North America and Australia have reported that men are at higher risk for diabetes than women.” – by Regina Schaffer
For more information:
Anne Jølle, MD, can be reached at the Norwegian University of Science and Technology, 7491 Trondheim, Norway; email: anne.jolle@ntnu.no.
Disclosure: Jølle reports no relevant financial disclosures.
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