Family Practice Advance Access originally published online on May 30, 2008
Family Practice 2008 25(3):191-196; doi:10.1093/fampra/cmn024
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A simple risk score identifies individuals at high risk of developing Type 2 diabetes: a prospective cohort study
a General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
b MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
Correspondence to Simon Griffin, MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Email: simon.griffin{at}mrc-epid.cam.ac.uk
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Abstract |
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Background. Randomized trials have demonstrated that Type 2 diabetes is preventable among high-risk individuals. To date, such individuals have been identified through population screening using the oral glucose tolerance test.
Objective. To assess whether a risk score comprising only routinely collected non-biochemical parameters was effective in identifying those at risk of developing Type 2 diabetes.
Methods. Population-based prospective cohort (European Prospective Investigation of Cancer-Norfolk). Participants aged 40–79 recruited from UK general practices attended a health check between 1993 and 1998 (n = 25 639) and were followed for a mean of 5 years for diabetes incidence. The Cambridge Diabetes Risk Score was computed for 24 495 individuals with baseline data on age, sex, prescription of steroids and anti-hypertensive medication, family history of diabetes, body mass index and smoking status. We examined the incidence of diabetes across quintiles of the risk score and plotted a receiver operating characteristic (ROC) curve to assess discrimination.
Results. There were 323 new cases of diabetes, a cumulative incidence of 2.76/1000 person-years. Those in the top quintile of risk were 22 times more likely to develop diabetes than those in the bottom quintile (odds ratio 22.3; 95% CI: 11.0–45.4). In all, 54% of all clinically incident cases occurred in individuals in the top quintile of risk (risk score > 0.37). The area under the ROC was 74.5%.
Conclusion. The risk score is a simple, effective tool for the identification of those at risk of developing Type 2 diabetes. Such methods may be more feasible than mass population screening with biochemical tests in defining target populations for prevention programmes.
Keywords. Diabetes, general practice, incidence, risk score, screening.
Rahman M, Simmons RK, Harding A-H, Wareham NJ and Griffin SJ. A simple risk score identifies individuals at high risk of developing Type 2 diabetes: a prospective cohort study. Family Practice 2008; 25: 191–196.