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Abstract
Objectives To evaluate the external validity of the FINDRISC, DESIR and ADA risk scores for the prediction of diabetes in a Spanish population aged >45 years and to test the possible improvement of FINDRISC by adding a new variable of high risk of depression when Patient Health Questionnaire-9 (PHQ-9) questionnaire score ≥10 (FINDRISC-MOOD).
Design Prospective population-based cohort study.
Setting 10 primary healthcare centres in the north of the city of Madrid (Spain).
Participants A total of 1242 participants without a history of diabetes and with 2-hour oral glucose tolerance test (OGTT) plasma glucose <200 mg/dL (<11.1 mmol/L) were followed up for 7.3 years (median) using their electronic health records (EHRs) and telephone contact.
Primary and secondary outcome measures Diabetes risk scores (FINDRISC, DESIR, ADA), PHQ-9 questionnaire and 2-hour-OGTT were measured at baseline. Incident diabetes was defined as treatment for diabetes, fasting plasma glucose ≥126 mg/dL (≥7.0 mmol/L), new EHR diagnosis or self-reported diagnosis. External validation was performed according to optimal cut-off, sensitivity, specificity and Youden Index. Comparison between diabetes risk scores, including FINDRISC-MOOD (original FINDRISC score plus five points if PHQ-9 ≥10), was measured by area under the receiver operating characteristic curve (AUROC).
Results During follow-up, 104 (8.4%; 95% CI, 6.8 to 9.9) participants developed diabetes and 185 had a PHQ-9 score ≥10. The AUROC values were 0.70 (95% CI, 0.67 to 0.72) for FINDRISC-MOOD and 0.68 (95% CI, 0.65 to 0.71) for the original FINDRISC. The AUROCs for DESIR and ADA were 0.66 (95% CI, 0.63 to 0.68) and 0.66 (95% CI, 0.63 to 0.69), respectively. There were no significant differences in AUROC between FINDRISC-MOOD and the other scores.
Conclusions The results of FINDRISC-MOOD were like those of the other risk scores and do not allow it to be recommended for clinical use.
- Risk Factors
- Surveys and Questionnaires
- General diabetes
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Supplementary materials
Supplementary Data
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Footnotes
Collaborators SPREDIA-2 Group: Leopoldo Pérez-Isla (Hospital Clínico de San Carlos), Ignacio Vicente (CS Monóvar), Sara Artola (CS Ma Jesús Hereza), Ma Isabel Granados-Menéndez (CS Monóvar), Domingo Beamud-Victoria (CS Felipe II), Isidoro Dujovne-Kohan (CS Los Castillos), Rosa María Chico-Moraleja (Hospital Central de la Defensa), Carmen Martín-Madrazo (CS Monóvar), Juan Cárdenas-Valladolid (Gerencia de Atención Primaria), Rosario Echegoyen de Nicolás (CS Benita de Ávila), Concepción Aguilera Linde (CS Ciudad Periodistas), Álvaro R Aguirre De Carcer Escolano (CS La Ventilla), Patricio Alonso Sacristán (CS Ciudad Periodistas), M Jesús Álvarez Otero (CS Dr Castroviejo), Paloma Arribas Pérez (CS Santa Hortensia), Maria Luisa Asensio Ruiz (CS Fuentelarreina), Pablo Astorga Díaz (CS Barrio Pilar), Begoña Berriatua Ena (CS Dr Castroviejo), Ana Isabel Bezos Varela (CS José Marva), María José Calatrava Triguero (CS Ciudad Jardín), Carlos Casanova García (CS Barrio Pilar), Ángeles Conde Llorente (CS Barrio Pilar), Concepción Díaz Laso (CS Fuentelarreina), Emilia Elviro García (CS Ciudad Periodistas), Orlando Enríquez Dueñas (CS Fuentelarreina), María Isabel Ferrer Zapata (CS El Greco), Froilán Antuña (CS Ciudad Periodistas), Maria Isabel García Lazaro (CS Ciudad Periodistas), Maria Teresa Gómez Rodríguez (CS Barrio Pilar), África Gómez Lucena (CS La Ventilla), Francisco Herrero Hernández (CS La Ventilla), Rosa Julián Viñals (CS Dr Castroviejo), Gerardo López Ruiz Ogarrio “in memoriam” (CS Barrio Pilar), Maria Del Carmen Lumbreras Manzano (CS José Marva), Sonsoles Paloma Luquero López (CS Ciudad Periodistas), Ana Martínez Cabrera Peláez (CS Barrio Pilar), Montserrat Nieto Candenas (CS La Ventilla), María Alejandra Rabanal Carrera (CS Barrio Pilar), Ángel Castellanos Rodríguez (CS Ciudad Periodistas), Ana López Castellanos (CS La Ventilla), Milagros Velázquez García (CS Barrio Pilar) and Margarita Ruiz Pacheco (CS Dr. Castroviejo).
Contributors MS-F, CDB-L, PG-C and FJSA-R contributed to conceptualisation, methodology, validation, formal analysis, writing—original draft and visualisation. JMM-P, CL-R, BF-P, EE-D, FG-I and TG-A contributed to investigation and resources. VMC-DR, VS, CS-R and SL-L contributed to supervision and validation. VI-C and BT contributed to review and editing. JC-V contributed to data curation and supervision. FR-A contributed to validation, final review and editing. The SPREDIA-2 group encouraged patient participation and supported patients during follow-up. They also facilitated data collection during the follow-up period. All authors contributed to the article and approved the submitted version.
Funding This work was supported by Instituto de Salud Carlos III (ISCIII) and was co-funded by the European Union. Grant numbers PI15/00259, PI18/01025 and PI22/01499.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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