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Ann Intern Med. 2009 Jun 2;150(11):741-51.

Two risk-scoring systems for predicting incident diabetes mellitus in U.S. adults age 45 to 64 years.

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  • 1Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA.

Abstract

BACKGROUND:

Simple prediction scores could help identify adults at high risk for diabetes.

OBJECTIVE:

To derive and validate scoring systems by using longitudinal data from a study that repeatedly tested for incident diabetes.

DESIGN:

Prospective cohort, divided into derivation and validation samples.

SETTING:

The ARIC (Atherosclerosis Risk in Communities) study, which followed participants for 14.9 years beginning in 1987 to 1989.

PARTICIPANTS:

12 729 U.S. adults (baseline age, 45 to 64 years; 22.8% black). Follow-up was 96.1% at 5 years and 72.2% at 10 years.

MEASUREMENTS:

Anthropometry, blood pressure, and pulse (basic system) plus a fasting blood specimen assayed for common analytes (enhanced system). Diabetes was identified in 18.9% of participants. Risk score integer points were derived from proportional hazard coefficients associated with baseline categorical variables and quintiles of continuous variables.

RESULTS:

The basic scoring system included waist circumference (10 to 35 points); maternal diabetes (13 points); hypertension (11 points); and paternal diabetes, short stature, black race, age 55 years or older, increased weight, rapid pulse, and smoking history (< or =8 points each). The enhanced system included glucose (6 to 28 points); waist circumference (5 to 21 points); maternal diabetes (8 points); and triglycerides, black race, paternal diabetes, low high-density lipoprotein cholesterol concentration, short stature, high uric acid, age 55 years or older, hypertension, rapid pulse, and nonuse of alcohol (< or =7 points each). When applied to the validation sample, ascending quintiles of the basic system were associated with a 10-year incidence of diabetes of 5.3%, 8.7%, 15.5%, 24.5%, and 33.0%, respectively. Quintiles of the enhanced system were associated with a 10-year incidence of 3.5%, 6.4%, 11.5%, 19.3%, and 46.1%.

LIMITATIONS:

The risk scoring systems had no question regarding previous gestational diabetes, and knowledge of parental diabetes may be uncertain. The analyzed cohort was restricted by age and race; the systems may be less effective in other samples.

CONCLUSION:

Basic information identified adults at high risk for diabetes. Additional data from fasting blood tests better identified those at extreme risk.

Comment in

PMID:
19487709
[PubMed - indexed for MEDLINE]
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