| Objective—To establish a cost-effective questionnaires screening method for undiagnosed diabetes in Chinese population,analyze the influence of the family history of diabetes and BMI,and evaluate the published typical Danish and Finish screening questionnaires and risk scores for undiagnosed diabetes in our Chinese population.Methods—Two target-population was selected to develop risk factors scoring method in order to identify people at increased risk for undiagnosed diabetes.Logistic regression analysis on the original data of group A was carried out to screen the related risk factors of diabetes.The score of the variables was determined based on theβ-coefficients;the score was used to predict the risk of the individual to develop diabetes.Both validity and effectiveness of the method developed in group A were evaluated in group B.Based on an epidemiological survey of diabetes mellitus, invested the target-population with screening questionnaire.Sensitivity,specificity, and the area under the receiver operating characteristic curve(AUC) for undiagnosed diabetes were calculated for various risk scores.Results—Age,body mass index(BMI),waist-hip ration(WHR),systolic pressure, diastolic pressure,pulse,family history of diabetes,history of hyperglycemia were selected as categorical variables.The Diabetes Risk Score value varied from 0 to 124. Results showed that the risk of having diabetes in the population increased along with aggregate scores of the individual,Trendχ2 test showed statistical significance (P＜0.001).When the threshold value of the screenning was set up at 51,both sensitivity and specificity of the method for identifying undiagnosed diabetes were 83.3%and 66.5%respectively,and making the positive predictive value 12.83%and negative predictive value 98.54%.The AUC was 0.820.Analysis showed after divided the population according to if they had family history of diabetes,in people with family history,the morbidity rate of diabetes and IGT were 9.9%and 20.1%.In those with family history,the morbidity rate of diabetes and IGT were 2.1%and 9.9%.Trendχ2 test showed statistical significance(P＜0.001).After divided the population with BMI,the study showed that in those with obese or overweight,the morbidity rate of diabetes and IGT were 6.7%and 17.5%, while in those with normal weight,the morbidity rate of diabetes and IGT were 1.1% and 7.0%.Trendχ2 test showed statistical significance(P＜0.001).When two screening tests(Finnish Diabetes Risk Score and Danish Diabetes Risk Score)were applied in our target population.The AUCs were 76%(95%confidence interval[CI],71.3%-80.6%) for the Finnish Diabetes Risk Score(P=0.00),70.6% (95%CI,64.7%-76.4%) for the Danish Diabetes Risk Score(P=0.00).The sensitivities,specificities,and predictive values of questionnaires were substantially lower than originally described,which was mainly due to population variation of risk factors(age,family history of diabetes,waist circumference,high blood glucose, antihypertensive medication,and food habit).Conclusion—The two-step screening program we developed is simple,inexpensive and noninvasive.After the questionnaires,the scores are calculated.If the scores are smaller than 51,the individuals are excluded from diabetes,and if they are larger than 51,then,the individuals enter the second step,a standard OGTT,to scan for diabetes. It can save much health expenses,especially in massive diabetes scanning.Age,BMI, WHR,systolic pressure,diastolic pressure,family history of diabetes,history of high glucose were the risk factors of diabetes.The diabetes morbidity rate of the population with family history of diabetes was higher than those without.And the diabetes morbidity rate of those with obesity or overweight was higher than those with normal weight.The most important risk factor that could be controlled was obesity.The morbidity of diabetes may be decreased if the risk factor,such as BMI, can be decreased to normal or nearly normal.Currently proposed questionnaires(such as Danish and Finish score models) yielded low validity when applied to a new population,most likely due to differences in population characteristics.Performance of diabetes risk questionnaires or scores must be assessed in the target population where they will be applied.The screening method we developed are simple,fast,inexpensive,and noninvasive.And it is a reliable tool to identify individuals at high risk for type 2diabetes.It is especially effective and useful for mass screening of T2DM. The study might be very important in the future screening of diabetes.
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