Poltavskiy Eduard, Kim Dae Jung, Bang Heejung
Graduate Group in Epidemiology, University of California, Davis, USA.
Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea.
Diabetes Res Clin Pract. 2016 Aug;118:146-53. doi: 10.1016/j.diabres.2016.06.022. Epub 2016 Jun 18.
There are numerous risk or screening scores for the prediction of type-2 diabetes mellitus (DM). In contrast, few scores are available for preDM. In this paper, we compare the two screening scores from the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) that can be used for DM as well as preDM.
Adult participants (N=9391) without known DM from the National Health and Nutrition Examination Surveys 2009-12 were included. We fitted the factors/items in the ADA and CDC scores in logistic regression with the outcomes of undiagnosed DM, preDM, and combination, and assessed the association and discrimination accuracy. We also evaluated the suggested cutpoints that define high risk individuals. We mimicked the original models/settings but also tested various deviations/modifications often encountered in practice.
Both scores performed well and robustly, while the ADA score performed somewhat better (e.g., AUC=0.77 for ADA and 0.73-0.74 for CDC for DM; 0.72-0.74 and 0.70-0.71 for preDM). The same predictors and scoring rules seem to be reasonably justified with different cutpoints for DM and preDM, which can make usage easier and consistent. Some factors such as race and HDL/LDL cholesterols may be useful additions to health education.
Current DM education and screening focus on the prevention and management of DM. The ADA and CDC scores could further help when we identify individuals at high risk for preDM, and teach the importance of preDM during which lifestyle intervention can be effective and urgently needed.
有许多风险或筛查评分可用于预测2型糖尿病（DM）。相比之下，用于糖尿病前期（preDM）的评分很少。在本文中，我们比较了美国糖尿病协会（ADA）和疾病控制与预防中心（CDC）的两种筛查评分，这两种评分可用于DM以及preDM。
纳入了2009 - 2012年国家健康与营养检查调查中无已知DM的成年参与者（N = 9391）。我们将ADA和CDC评分中的因素/项目纳入逻辑回归模型，以未诊断的DM、preDM及两者合并的情况作为结果，评估其关联性和判别准确性。我们还评估了定义高危个体的建议切点。我们模仿了原始模型/设置，但也测试了实践中经常遇到的各种偏差/修改。
两种评分表现良好且稳健，而ADA评分表现稍好（例如，对于DM，ADA的AUC = 0.77，CDC的AUC = 0.73 - 0.74；对于preDM，ADA的AUC = 0.72 - 0.74，CDC的AUC = 0.70 - 0.71）。相同的预测因素和评分规则对于DM和preDM采用不同的切点似乎是合理的，这可以使使用更简便和一致。一些因素，如种族和高密度脂蛋白/低密度脂蛋白胆固醇，可能有助于加强健康教育。
当前的DM教育和筛查侧重于DM的预防和管理。当我们识别出preDM高危个体，并传授preDM的重要性（在此期间生活方式干预可能有效且迫切需要）时，ADA和CDC评分可能会提供进一步帮助。
