IJCRR

IJCRR - 9(3), February, 2017

Pages: 39-42

Date of Publication: 10-Feb-2017

Indian Diabetic Risk Score- A Tool For Predicting Risk Of Undiagnosed Type 2 Diabetes Mellitus

Author: Sheikh Mohd Saleem1, Adnan Firdous Raina2, S. Muhammad Salim Khan3, Shah Sumaya Jan4

Category: Healthcare

Abstract:Objectives: The objective of the study was to assess the performance of the Indian Diabetic Risk Score (IDRS) questionnaire for detecting and predicting risk of Type 2 diabetes mellitus (T2DM) in patients attending a primary health centre.
Material and Methods: We conducted a cross-sectional study comprising 1530 adult participants, age (>20 yrs) attending Outpatient department of a primary health centre located at Harwan, district Srinagar without a diagnosis of Type 2 diabetes mellitus. The risk of developing Type 2 diabetes mellitus was assessed using the validated and widely used Indian diabetic risk score. Total Risk Score of each participant was analysed and compared.
Results: Data on 1530 participants with unknown diabetes mellitus were analysed with the mean age of 51.5 years, majority 54% females, 64.18% belonging to nuclear family and majority were from lower middle socio economic status. Around 99.73% were non vegetarian population with 19.15% having smoking habits. According to Indian diabetic risk score of Madras diabetic research federation the study population were classified to be low, medium and high risk for developing type 2 diabetes were 70.4%, 19.5% and 10.1% respectively.
Conclusion: The IDRS questionnaire designed by Madras Diabetic Research Foundation is a useful screening tool to identify unknown Type 2 diabetes mellitus. The questionnaire is a reliable, valuable and easy to use screening tool which can be used in a primary care setup and better convince people at high risk of Type 2 diabetes mellitus to take action towards healthier lifestyle habits.

Keywords: Indian diabetic risk score; Type 2 diabetes mellitus; Prediabetes; Screening; Saleem IDRS

Full Text:

INTRODUCTION

The prevalence of diabetes is on an increase due to over growth of population, urban life style, physical inactivity, aging and increasing prevalence of obesity. Diabetes mellitus (DM) affects around 8.3% of worlds adult population, and World health organisation has predicted the total number of cases of diabetes mellitus to rise from 371 million in 2012 to 552 million in 2030 [1]. Due to such a huge burden diabetes mellitus has become one of the most common  non-communicable  diseases affecting all age  groups in urban  and  rural population  without  urban  rural  differences.[2,3] The burden has reached to such limits that we may find a diabetic patient in each house hold in India in coming future. According to WHO SEARO 3, the projected increase by year 2025 will be 70 million diabetic patients in India posing a huge burden to the economic and health care system of country. The patients with Type 2 diabetes Mellitus may often remain asymptomatic for a longer period of time with abnormal blood glucose, cholesterol and triglycerides. In fact, their diagnosis is often delayed until the development of complications or the disease is diagnosed incidentally by a health professional. Moreover, the management of diabetes with complications is more difficult and expensive. Studies have documented that patients with diabetes Mellitus or impaired glucose tolerance had already developed subclinical atherosclerosis even before diagnosis of diabetes mellitus is confirmed [4]. Therefore, early diagnosis of diabetes mellitus could favour the implementation of preventive measures aimed at preventing complications associated with diabetes mellitus. Furthermore, every year around 5%-10% of individuals with impaired fasting glycaemia and impaired glucose tolerance have a greater risk of being diagnosed with Type 2 diabetes mellitus [5]. It is well understood that Type 2 diabetes mellitus is a preventable disease, so earlier detection of population at risk and subsequent follow-up with interventional strategies can prevent Type 2 diabetes mellitus, improve glycemic control, and decrease its incidence in the population and complication associated with it. [6]. Diabetes mellitus risk scores [7] is  an easy, less time consuming, non-invasive, and cost effective approach to  assess an individual’s risk of Undiagnosed Type 2 diabetes mellitus and dysglycaemia. In our study we have used Indian Diabetes Risk Score (IDRS) developed  by  Madras  Diabetes  Research  Foundation  and Ramachandran  A  et  al.[8,9] which is one of the most frequently used instruments for assessing the risk of diabetes mellitus  for Indian population. It comprises of only four variables like Age, Waist circumference, Family history of diabetes and daily physical activity. Indian diabetes risk score assesses whether an individual has undiagnosed Type 2 Diabetes Mellitus or dysglycaemia or the probability of developing Type 2 diabetes mellitus during the following 10 years. Many studies have been done outside Kashmir, India to validate the ability of the Indian diabetes risk score for detection of undiagnosed Type 2 Diabetes Mellitus. However, to our knowledge; no studies have examined the validation of score for detection of undiagnosed Type 2 Diabetes Mellitus in Kashmiri population. We performed this study to evaluate the performance of Indian diabetic risk score for screening of undiagnosed Type 2 Diabetes Mellitus and any dysglycaemia in a representative sample of the kashmiri population living in Harwan Zone, District Srinagar.

MATERIAL AND METHODS

A cross-sectional study was undertaken to evaluate the performance of Indian Diabetes Risk Score among adult patients (age >20 years) attending outpatient department of a primary health centre located at Harwan, district Srinagar. Prior ethical clearance from the departmental head and ethical committee was sought out and only those patients who gave written informed consent were included in the study. A total of 1530 patients participated in the study from January 2016 to July 2016. Each participant was selected using systematic sampling where every third adult patient (age >20 years) attending the Outpatient department of primary health care centre was included in the study. Participants with known diabetes mellitus and pregnant women were excluded from the study. We used Indian Diabetes Risk Score designed by Madras diabetes Research association and Ramachandran et al which is one of the most frequently used instruments for assessing the risk of diabetes mellitus in India. An  IDRS value > or = 60 had the optimum  sensitivity (72.5 %) and specificity  (60.1%)  for  determining  undiagnosed  diabetes with  a  positive  predictive  value  of  17.0%,  negative predictive value of  95.1%, and accuracy of 61.3%.[8] Sociodemographic, Anthropometric parameters, Lifestyle factors, Age, BMI, Waist circumference, Family history of diabetes, Use of blood pressure medication, History of elevated blood glucose, Daily physical activity, and daily consumption of vegetables, fruit, and berries were taken into account and recorded on a pre designed Proforma. Total Risk Score of each participant was analysed and compared. Subjects with IRDS score of <30 was categorized as low risk, 30-50 as medium risk and those with score ≥60 as high risk for diabetes.

Outcome  measures:  The  outcomes  are  expressed  in percentages  based  on  low,  medium  and  high  risk  of developing  diabetes  using  the  IDRS  risk  score.  The minimum score is 0 and the maximum score is 100 and positive score is ≥ 60.

RESULTS

Our  study  included  1530  study  participants  with  the  mean age  of  51.5  years, 54% of participants were women, 64.18% were from nuclear families and most of the participants were from lower middle socioeconomic status. Around 99.73% were non-vegetarian with 19.15%  having smoking habits (Table  1).  According  to  Indian diabetic risk score, 70.4%,  19.5%  and  10.1% study  population  were  classified  to  be  low, medium  and  high  risk  for  developing  type  2  diabetes .(Table 2 and Figure 1). Table 3 Shows different variables used in Indian diabetic risk score screening questionnaire and their scoring system.   Approximately 34% were more than 50 years of age, 13% had high abdominal obesity by waist circumference, 32% were having sedentary habits and 18% had family history of diabetes in both parents.

DISCUSSION:

There are many screening questionnaires and tools developed by various national and international diabetic associations throughout the world, which vary according to the ethnic group, life style and races. Indian Diabetic Risk score (IDRS) is one such screening tool which is clear and easy to use tool developed by Madras Diabetic Research Foundation (MDRF) [8,9] which takes in account only four risk factors like age, waist circumference, physical  activity and family  history. Indian diabetic risk score is unique in a way that it takes measurement of waist circumference as a measure of abdominal obesity because Indian population is a characteristic of Type 2 diabetes mellitus with lean body mass index. So instead of body mass index, the use of waist circumference in the  screening  makes  it  a  better  screening  tool  for assessing Type 2 diabetes mellitus, since  the  Finnish  group diabetes  risk  score  has  included  both  body mass index  and  waist circumference having family history  and  the  physical  activity  and  measurement  of waist circumference as a  measure of abdominal obesity [12]. This plays a very important role in determining the role of developing type 2 diabetes. The Indian diabetic risk score has a sensitivity of 72.5% and specificity of 60.1% based on  the largest population based study on diabetes in India CURES [12].

In this study we report on Indian Diabetes Risk Score. Use of such a scoring system is of great significance and could prove to be cost-effective, easy to use, reliable, and valuable screening tool for detecting risk of diabetes. In countries like India where there is a marked explosion of diabetes and over half of the cases remain undiagnosed, Indian diabetic risk score may be used by primary care physicians at a primary care setup in determining risk of developing diabetes mellitus.

The current study assessed the performance of the Indian diabetic risk score questionnaire, and clearly demonstrates that this scoring system can work reasonably well as screening tool, detecting undiagnosed Type 2 diabetes mellitus in the general population. Findings in this study showed a positive association between the Indian diabetic risk score and undiagnosed Type 2 diabetes mellitus in the general population. Using the cut-off Score values of greater or equal to 60 in both men and women, this screening tool had good performance in identifying undiagnosed Type 2 diabetes mellitus. 

Studies have shown that Type 2 diabetes mellitus is a major and an important independent risk factor for developing cardiovascular disease and death [10]. Therefore, early identification of people with undiagnosed Type 2 diabetes mellitus and detecting people at risk for developing Type 2 diabetes mellitus in near future is essential for early implementation of preventive measures, reducing   economic costs and morbidity associated with diabetic complications.[11]. Type 2 diabetes mellitus is a disease with high prevalence and low incidence so its detection is often delayed and at the time of diagnosis, advanced complications are often present. Hence, using IRDS score which is a simplified and valid questionnaire as a preliminary screening tool followed with more invasive and correct diagnosis in primary care constitute a cost-effective and practical method with a potentially high national impact in terms of public health [12].

Limitation of the study: First, the participants were drawn from a single primary healthcare centre located at Harwan, district Srinagar and, thus, the results may not be applicable to the rest of Jammu and Kashmir state. Secondly, diagnosis of Type 2 diabetes mellitus using biochemical markers was not done and no such invasive procedures were carried out.

CONCLUSION:

The Indian diabetic risk score questionnaire designed by Madras diabetic research federation is a useful screening tool to identify unknown Type 2 diabetes mellitus. The questionnaire is a reliable, valuable and easy to use screening tool which can be used in a primary care setup. The findings of our study may aid in convincing health care professionals and people at high risk of developing diabetes to take stern action towards healthy lifestyle and achieving the goal of “Health for all”.

References:

1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94(3):311–2. doi:10.1016/j.diabres.2011.10.029 PMID:22079683
2.  Gupta OP, Joshi MH, Dave SK. Prevalence of Diabetes in India. Adv Metab Disord.1978;9:147-65
3. Chow CK, Raju PK, Raju R, Reddy KS. The prevalence and  management  of  Diabetes in rural India. Diabetes Care. 2006;29:1717-8
4. Gong W, Lu B, Yang Z, Ye W, Du Y, Wang M, et al. Early-stage atherosclerosis in newly diagnosed, untreated type 2 diabetes mellitus and impaired glucose tolerance. Diabetes Metab 2009; 35(6):458–62. doi:10.1016/j.diabet.2009.05.005PMID:19879790
5. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al; American Diabetes Association. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007; 30(3):753–9. PMID:17327355
6. Lindström J, Peltonen M, Eriksson JG, Aunola S, Hämäläinen H, Ilanne-Parikka P, et al; Finnish Diabetes Prevention Study (DPS) Group. Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study. Diabetes Care 2008; 31(5):857–62. doi:10.2337/dc07-2162PMID: 18252900
7. Lee CM, Colagiuri S. Risk scores for diabetes prediction: the International Diabetes Federation PREDICT-2 project. Diabetes Res Clin Pract 2013; 100(2):285–6. doi:10.1016/j.diabres.2013.01.024 PMID:23415425
8. Mohan V, Deepa R, Deepa M, Somannavar S, Datta M.A simplified Indian Diabetes  Risk  Score  for screening for undiagnosed diabetic subjects. J Assoc Physicians India. 2005;53:75 63
9. Ramachandran A, Snehalatha C, Vijay V, Wareham NJ, Colagiuri  S. Derivation  and  validation  of diabetes risk score for urban Asian Indians. Diabetes Res Clin Pract. 2005;70(1):63-70.
10. Narayan KM, Gregg EW, Fagot-Campagna A, Engelgau MM, Vinicor F. Diabetes--a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract2000; 50Suppl 2: S77-S84 [PMID: 11024588 DOI: 10.1016/S0168-8227(00)00183-2]
11. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care2014; 37Suppl 1: S14-S80 [PMID: 24357209 DOI: 10.2337/dc14-S014]
12. Nagalingam S, Sundaramoorthy K, Arumugam B. Screening for diabetes using Indian diabetes risk score. Int J Adv Med 2016;3:415-8