Original articleValidation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in GreeceValidation du questionnaire finlandais calculant un score de risque de diabète (FINDRISC) pour le dépistage du diabète de type 2, des anomalies de la glycorégulation et du syndrome métabolique en Grèce
Introduction
The frequency of type 2 diabetes (T2D) is increasing worldwide to nearly epidemic proportions as the general population becomes older, less active and more obese. Its future burden is expected to increase dramatically, with increases in both long-term morbidity and mortality. Furthermore, it is estimated that approximately one-third of all people with diabetes may be undiagnosed [1]. The economic burden of treating diabetes and its complications is likewise enormous. For this reason, effective primary prevention programmes for T2D are urgently needed to reduce the clinical and economic healthcare burden.
The disease is characterized by a long prediabetic period, during which impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and many of the components of the metabolic syndrome (MetS) interact to finally end with overt clinical diabetes [2]. Many studies have shown that interventions at the prediabetic state using either lifestyle modifications [3], [4] or medications [5], [6] can prevent, or at least delay, progression of the disease. This means that the identification of those at high risk for T2D is warranted to allow for a more timely implementation of preventative action aimed at reducing their risk [7]. This has been recently shown to be cost-effective as well [8].
Measuring plasma glucose (either fasting or 2 h after an oral glucose tolerance test [OGTT]) and glycosylated haemoglobin (HbA1c) levels are the recommended methods for screening the general population [9]. However, these are invasive procedures, costly and time-consuming (especially OGTT) and, thus, not suitable for mass screening. Furthermore, as they are based solely on measuring glycaemia, they may diagnose the disease too late, when complications have already occurred [10].
The MetS is a cluster of metabolic risk factors for cardiovascular disease (CVD) that are associated with insulin resistance. The presence of the MetS predicts the future development of both T2D and CVD. Diagnosing the syndrome, however, requires measuring five clinical and biochemical parameters, whereas its predictive ability does not appear to surpass other, simpler risk-assessment tools, such as the Framingham risk score (for predicting CVD) or simple plasma glucose measurement (for predicting T2D) [11].
Recently, many attempts have been made to develop simple, fast, non-invasive and practical screening tools for identifying individuals at high risk of future development of T2D [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Of these tools, the Finnish Type 2 Diabetes Risk Score (FINDRISC) questionnaire [12] is widely used, and has already been validated in different, but mostly Caucasian [12], [22], [23], [24], [25], [26], [27], populations for detecting unknown diabetes, abnormal glucose tolerance and the MetS.
It is questionable, however, to what extent screening protocols, such as risk-score assessment followed by blood glucose measurements, that have been developed in one population can be applied in other countries’ populations [28]. As the effectiveness of the FINDRISC questionnaire has not yet been studied in Greece, the aim of the present study was to validate the questionnaire in a population-based, cross-sectional setting in Greece, and to study its performance as a screening tool for undetected T2D, other abnormalities of glucose homoeostasis and the MetS in middle-aged individuals.
Section snippets
Subjects and methods
Validation was performed using the baseline data from a cross-section of participants in a T2D prevention program in Greece, using both the FINDRISC questionnaire and OGTT [29]. The main aim of this EU-funded project (Diabetes in Europe–Prevention using Lifestyle, Physical Activity and Nutritional Intervention, DE–PLAN) was to establish a model for the efficient identification of community-living individuals at high risk of T2D in EU member countries, as well as to test the feasibility and
Results
The demographic, clinical and laboratory characteristics of our study participants are presented in Table 1. The prevalence of undiagnosed diabetes (based on OGTT results) was 10.8%, while that of dysglycaemia (IFG + IGT + T2D) was 33.6%, with significant differences between genders (higher in men). However, the prevalence of the MetS (38.4%) did not differ between men and women.
Of the total 869-screened participants, 840 had complete FINDRISC data, and a marked increase in the prevalence of
Discussion
The American Diabetes Association (ADA) recommends screening for T2D at 3-year intervals, beginning at age 45 years, especially in those with a BMI greater or equal to 25 kg/m2 [34]. However, these recommendations are not widely followed, as indicated by the fact that one-third of those who have diabetes go undiagnosed [1]. As the main reason for this problem is the cost and inconvenience of diabetes testing [35], one way to address the issue is to develop a simple, inexpensive tool that can
Conclusion
The present study has validated the FINDRISC questionnaire as a useful screening tool to identify unknown diabetes, abnormal glucose homoeostasis and the MetS in a cross-section of the Greek population. The questionnaire was originally developed in a prospective setting to identify those at high risk of developing T2D in the future. The performance of the questionnaire in the present study was good, and comparable to its performance in the other Caucasian populations tested [22], [23], [24],
Conflict of interest statement
None of the authors have any conflict of interest to declare.
Acknowledgements
The present study was supported by the Commission of the European Communities, Directorate C–Public Health and Risk Assessment, Health & Consumer Protection, Grant Agreement number 2004310, and the DE–PLAN project. It was also co-funded by the private sector – in this case, an unrestricted educational grant from Bristol-Myers Squibb in Greece. We would also like to thank the following health centers and individuals for their help in implementing the present study: the medical staff of the
References (40)
- et al.
Acarbose for prevention of type 2 diabetes mellitus: the stop-NIDDM randomized trial
Lancet
(2002) - et al.
External validation is necessary in prediction research: a clinical example
J Clin Epidemiol
(2003) - et al.
Full accounting of diabetes and pre-diabetes in the U.S. Population in 1988–1994 and 2005–2006
Diabetes Care
(2009) The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes
Diabetologia
(2003)- et al.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance
N Engl J Med
(2001) - et al.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N Engl J Med
(2002) - et al.
Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial
Lancet
(2006) - et al.
A European evidence-based guideline for the prevention of type 2 diabetes
Horm Metab Res
(2010) - et al.
Screening for type 2 diabetes: literature review and economic modelling
Health Technol Assess
(2007) Diagnosis and classification of diabetes mellitus
Diabetes Care
(2010)
Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?
JAMA
Role of the metabolic syndrome in risk assessment for coronary heart disease
JAMA
The diabetes risk score: a practical tool to predict type 2 diabetes risk
Diabetes Care
A Danish diabetes risk score for targeted screening: the inter99 study
Diabetes Care
Performance of a predictive model to identify undiagnosed diabetes in a health care setting
Diabetes Care
Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test?
Ann Intern Med
Diabetes risk score: towards earlier detection of type 2 diabetes in general practice
Diabetes Metab Res Rev
Screening for type 2 diabetes and impaired glucose metabolism: the Australian experience
Diabetes Care
A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes
Diabetes Care
Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule
Diabetes Care
Cited by (139)
Body physique rating as a factor to identify at-risk Mexicans for Metabolic Syndrome
2023, Human Nutrition and MetabolismDo parental risk factors for type 2 diabetes predict offspring risk of overweight and obesity? The Feel4Diabetes study
2023, NutritionCitation Excerpt :In the setting of examining risk factors for T2D, the most widely used diabetes risk score is the Finnish Diabetes Risk Score (FINDRISC), enabling the identification of people at increased risk of developing T2D over the following 10 y [16]. This questionnaire has been widely validated [17–19], and is recommended by international health organizations, such as the American Diabetes Association [20]. Obtaining information on parental characteristics using this tool is of great advantage because of its low cost, ease of use, acceptability, and ability to provide a reflection of shared genetic, lifestyle, and environmental factors with their offspring.
Kernel machine learning methods to handle missing responses with complex predictors. Application in modelling five-year glucose changes using distributional representations
2022, Computer Methods and Programs in BiomedicineThree-stage intelligent support of clinical decision making for higher trust, validity, and explainability
2022, Journal of Biomedical InformaticsCitation Excerpt :It was validated in the Russian population and showed good results [80]. This questionnaire was also tested on populations of other countries and showed a high quality of the prediction [81,82]. However, this method assesses the risk over the next ten years.
Benefit of Finnish Score As a Risk Assessment Tool for Predicting Type II DM Among Sudanese Population in North Sudan
2024, Sudan Journal of Medical Sciences