Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Diabetologia. 2011 May;54(5):1004-12. doi: 10.1007/s00125-010-1990-7. Epub 2010 Dec 12.
AIMS/HYPOTHESIS: The Finnish diabetes risk questionnaire is a widely used, simple tool for identification of those at risk for drug-treated type 2 diabetes. We updated the risk questionnaire by using clinically diagnosed and screen-detected type 2 diabetes instead of drug-treated diabetes as an endpoint and by considering additional predictors.
Data from 18,301 participants in studies of the Evaluation of Screening and Early Detection Strategies for Type 2 Diabetes and Impaired Glucose Tolerance (DETECT-2) project with baseline and follow-up information on oral glucose tolerance status were included. Incidence of type 2 diabetes within 5 years was used as the outcome variable. Improvement in discrimination and classification of the logistic regression model was assessed by the area under the receiver-operating characteristic (ROC) curve and by the net reclassification improvement. Internal validation was by bootstrapping techniques.
Of the 18,301 participants, 844 developed type 2 diabetes in a period of 5 years (4.6%). The Finnish risk score had an area under the ROC curve of 0.742 (95% CI 0.726-0.758). Re-estimation of the regression coefficients improved the area under the ROC curve to 0.766 (95% CI 0.750-0.783). Additional items such as male sex, smoking and family history of diabetes (parent, sibling or both) improved the area under the ROC curve and net reclassification. Bootstrapping showed good internal validity.
CONCLUSIONS/INTERPRETATION: The predictive value of the original Finnish risk questionnaire could be improved by adding information on sex, smoking and family history of diabetes. The DETECT-2 update of the Finnish diabetes risk questionnaire is an adequate and robust predictor for future screen-detected and clinically diagnosed type 2 diabetes in Europid populations.
目的/假设：芬兰糖尿病风险问卷是一种广泛使用的、简单的工具，用于识别有药物治疗 2 型糖尿病风险的人群。我们通过使用临床诊断和筛查发现的 2 型糖尿病代替药物治疗的糖尿病作为终点，并考虑了其他预测因素，对风险问卷进行了更新。
该研究纳入了评估 2 型糖尿病和糖耐量受损筛查和早期检测策略（DETECT-2）项目中 18301 名参与者的数据，这些参与者具有基线和随访时口服葡萄糖耐量状态的信息。5 年内发生 2 型糖尿病的发生率作为结局变量。通过接受者操作特征（ROC）曲线下面积和净重新分类改善来评估逻辑回归模型的区分度和分类能力的改善。内部验证采用自举技术。
在 18301 名参与者中，844 人在 5 年内发生了 2 型糖尿病（4.6%）。芬兰风险评分的 ROC 曲线下面积为 0.742（95%CI 0.726-0.758）。重新估计回归系数可将 ROC 曲线下面积提高至 0.766（95%CI 0.750-0.783）。增加男性、吸烟和糖尿病家族史（父母、兄弟姐妹或两者都有）等额外项目可以提高 ROC 曲线下面积和净重新分类。自举法显示了良好的内部有效性。
结论/解释：通过添加性别、吸烟和糖尿病家族史信息，可以提高原始芬兰风险问卷的预测价值。DETECT-2 更新后的芬兰糖尿病风险问卷是欧洲人群未来筛查发现和临床诊断的 2 型糖尿病的一种充分且稳健的预测因子。
