Performance of Stepwise Screening Methods in Identifying Individuals at High Risk of Type ۲ Diabetes in an Iranian Population

Background Recent evidence recommended stepwise screening methods for identifying individuals at high risk of type ۲ diabetes to be recruited in the lifestyle intervention programs for the prevention of the disease. This study aims to assess the performance of different stepwise screening methods that combine non-invasive measurements with lab-based measurements for identifying those with ۵-years incident type ۲ diabetes. Methods  ۳۰۳۷ participants aged ≥۳۰ years without diabetes at baseline in the Tehran Lipid and Glucose Study (TLGS) were followed. Thirty-two stepwise screening methods were developed by combining a non-invasive measurement (an anthropometric measurement (waist-to-height ratio, WtHR) or a score based on a non-invasive risk score [Australian Type ۲ Diabetes Risk Assessment Tool, AUSDRISK]) with a lab-based measurement (different cut-offs of fasting plasma glucose [FPG] or predicted risk based on three lab-based prediction models [Saint Antonio, SA; Framingham Offspring Study, FOS; and the Atherosclerosis Risk in Communities, ARIC]). The validation, calibration, and usefulness of lab-based prediction models were assessed before developing the stepwise screening methods. Cut-offs were derived either based on previous studies or decision-curve analyses. Results  ۲۰۳ participants developed diabetes in ۵ years. Lab-based risk prediction models had good discrimination power (area under the curves [AUCs]: ۰.۸۰-۰.۸۳), achieved acceptable calibration and net benefits after recalibration for population’s characteristics and were useful in a wide range of risk thresholds (۵%-۲۱%). Different stepwise methods had sensitivity ranged ۲۰%-۶۸%, specificity ۷۰%-۹۸%, and positive predictive value (PPV) ۱۴%-۴۶%; they identified ۳%-۳۳% of the screened population eligible for preventive interventions. Conclusion  Stepwise methods have acceptable performance in identifying those at high risk of incident type ۲ diabetes.

Keywords:

Primary Prevention , Type ۲ diabetes , Stepwise Screening , Prediction Models , External Validation