Highlights
- •The ADA risk score is valid for screening undiagnosed T2DM in the Iranian population.
- •The ADA cut off 5 has a good power to classify the low and high-risk individuals.
- •The cut off 4 could also be recommended by policymakers and professionals.
Abstract
Aims
The aim of this study is to assess the American Diabetes Association (ADA) risk score
as a self-assessment screening tool for undiagnosed type 2 diabetes (T2DM) in Iran.
Methods
In a national survey of risk factors for non-communicable diseases, we included 3458
Iranian adults. The discrimination and validity were assessed using the area under
the curve (AUC), sensitivity, specificity, Youden's index, positive and negative predictive
values (PPV and NPV). The frequency of high-risk Iranian population who need a glucose
test and those who need intervention were also estimated.
Results
The AUC was 73.7% and the suggested ADA score of ≥5 yielded a sensitivity of 51.6%,
specificity 82.4%, NPV 98.3%, and PPV 7.9%. This threshold results in classifying
18.6% of the Iranians, equals to 8.5 million, as high-risk and 1.5% of the population,
about 700,000, would need intervention. However, our study suggested score ≥4 that
identified 34% of the population as high-risk and 2% of the population would need
intervention.
Conclusion
Our findings support the ADA suggested threshold for identifying high-risk individuals
for undiagnosed T2DM; however, a lower threshold is also recommended for higher sensitivity.
The ADA screening tool could help the public health system for low-cost screening.
Abbreviations:
T2DM (Type 2 diabetes), MENA (the Middle East and North Africa region), FPG (fasting plasma glucose), 2h-PCPG (2-h post-challenge plasma glucose), HbA1c (hemoglobin A1c), ADA (American Diabetes Association), PPV and NPV (positive and negative predictive values), SuRFNCD (non-communicable Diseases), BMI (body mass index), SBP (systolic blood pressure), DBP (diastolic blood pressure), IraPEN (Package of Essential NCD interventions), CV (coefficients of variation), GPAQ (global physical activity questionnaire), LR (likelihood ratio), TC (total cholesterol), LDL-C (low-density lipoprotein-cholesterol), TG (triglyceride), AUC (area under the receiver-operating characteristic curve)Keywords
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Article info
Publication history
Published online: June 07, 2020
Accepted:
April 1,
2020
Received in revised form:
March 26,
2020
Received:
November 1,
2019
Identification
Copyright
© 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
