Heikes Kenneth E, Eddy David M, Arondekar Bhakti, Schlessinger Leonard
Archimedes, San Francisco, California, USA.
Diabetes Care. 2008 May;31(5):1040-5. doi: 10.2337/dc07-1150. Epub 2007 Dec 10.
The objective of this study was to develop a simple tool for the U.S. population to calculate the probability that an individual has either undiagnosed diabetes or pre-diabetes.
We used data from the Third National Health and Nutrition Examination Survey (NHANES) and two methods (logistic regression and classification tree analysis) to build two models. We selected the classification tree model on the basis of its equivalent accuracy but greater ease of use.
The resulting tool, called the Diabetes Risk Calculator, includes questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history, and exercise. Each terminal node specifies an individual's probability of pre-diabetes or of undiagnosed diabetes. Terminal nodes can also be used categorically to designate an individual as having a high risk for 1) undiagnosed diabetes or pre-diabetes, 2) pre-diabetes, or 3) neither undiagnosed diabetes or pre-diabetes. With these classifications, the sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic area for detecting undiagnosed diabetes are 88%, 75%, 14%, 99.3%, and 0.85, respectively. For pre-diabetes or undiagnosed diabetes, the results are 75%, 65%, 49%, 85%, and 0.75, respectively. We validated the tool using v-fold cross-validation and performed an independent validation against NHANES 1999-2004 data.
The Diabetes Risk Calculator is the only currently available noninvasive screening tool designed and validated to detect both pre-diabetes and undiagnosed diabetes in the U.S. population.
本研究的目的是开发一种简单工具，供美国人群计算个体患有未诊断糖尿病或糖尿病前期的概率。
我们使用了第三次全国健康与营养检查调查（NHANES）的数据，并采用两种方法（逻辑回归和分类树分析）构建了两个模型。基于其同等的准确性但更高的易用性，我们选择了分类树模型。
由此产生的工具称为糖尿病风险计算器，包括关于年龄、腰围、妊娠糖尿病、身高、种族/族裔、高血压、家族史和运动的问题。每个终端节点指定个体患糖尿病前期或未诊断糖尿病的概率。终端节点也可用于分类指定个体为具有以下高风险之一：1）未诊断糖尿病或糖尿病前期，2）糖尿病前期，或3）既无未诊断糖尿病也无糖尿病前期。通过这些分类，检测未诊断糖尿病的敏感性、特异性、阳性和阴性预测值以及受试者工作特征曲线下面积分别为88%、75%、14%、99.3%和0.85。对于糖尿病前期或未诊断糖尿病，结果分别为75%、65%、49%、85%和0.75。我们使用v折交叉验证对该工具进行了验证，并针对1999 - 2004年NHANES数据进行了独立验证。
糖尿病风险计算器是目前唯一一种经设计和验证可用于检测美国人群中糖尿病前期和未诊断糖尿病的非侵入性筛查工具。
