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Arch Iran Med. 2019;22(3):116-124.
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Original Article

Non-invasive Risk Prediction Models in Identifying Undiagnosed Type 2 Diabetes or Predicting Future Incident Cases in the Iranian Population

Mojtaba Lotfaliany 1,2, Farzad Hadaegh 2, Samaneh Asgari 2, Mohammad Ali Mansournia 3, Fereidoun Azizi 4, Brian Oldenburg 1, Davood Khalili 2,5 *

1 School of Population and Global Health, University of Melbourne, Australia
2 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
*Corresponding Author: Davood Khalili, MD, MPH, PhD; Ass. Professor of Epidemiology, Prevention of Metabolic Disorders Research Center, & Head of Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Postal Address: No. 23, Parvaneh Street, Velenjak, Tehran, Iran. Phone: +98-21- 22432500; Fax: +98-21- 22416264; Email: Email: dkhalili@endocrine.ac.ir

Abstract

Background: Iran needs pragmatic screening methods for identifying those with undiagnosed type 2 diabetes or at high risk of developing it. The aim of this study was to assess performance of three non-invasive risk prediction models, i.e. the Finnish Diabetes Risk Score (FINDRISC), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), and the American Diabetes Association Risk Score (ADA), for identifying those with undiagnosed type 2 diabetes (prevalent type 2 diabetes at baseline without any treatment) or those who would develop type 2 diabetes within 5 years of follow-up

Methods: 3467 participants aged ≥30 years without treated type 2 diabetes in the Tehran Lipid and Glucose Study (TLGS) were included in this study. The discrimination power of models was assessed by area under the curve (AUC), their calibrations were assessed by calibration plots and Hosmer–Lemeshow test, and their net benefits were assessed by decision curves.

Results: 430 participants had undiagnosed type 2 diabetes at baseline and 203 developed type 2 diabetes during 5 years of followup. AUSDRISK had the highest AUC (0.77) as compared to FINDRISC (0.75; P value: 0.014), and the ADA model (0.73; P value: <0.001). The original model for AUSDRISK and calibrated versions of FINDRISC and ADA models had acceptable calibration (Hosmer–Lemeshow chi-square <20) and these models were clinically useful in a wide range of risk thresholds as their net benefit was higher than no-screening scenarios.

Conclusion: The original AUSDRISK model and recalibrated models for FINDRISC and ADA are valid and effective tools for identifying those with undiagnosed or 5-year incident type 2 diabetes in Iran.

Keywords: High risk individuals, Non-invasive risk prediction models, Screening methods, Type 2 diabetes
Cite this article as: Lotfaliany M, Hadaegh F, Asgari S, Mansournia MA, Azizi F, Oldenburg B, et al. Non-invasive risk prediction models in identifying undiagnosed type 2 diabetes or predicting future incident cases in the Iranian population. Arch Iran Med. 2019;22(3):116–124.
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Submitted: 01 Oct 2018
Accepted: 16 Jan 2019
First published online: 01 Mar 2019
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