Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Public Health Agency of Canada, Ottawa, Ontario, Canada.
Health Promot Chronic Dis Prev Can. 2018 Feb;38(2):55-63. doi: 10.24095/hpcdp.38.2.02.
First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia.
Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables.
Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability.
CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.
与其他加拿大人相比，第一民族/梅蒂斯人群更早且更频繁地患上糖尿病。加拿大糖尿病风险问卷（CANRISK）是一种为 40 岁及以上的加拿大人设计的糖尿病筛查工具。本文的主要目的是评估现有的 CANRISK 工具和风险评分在检测第一民族/梅蒂斯参与者（包括 40 岁以下的参与者）的糖基化异常方面的有效性。次要目的是确定使用 CANRISK 变量的替代腰围（WC）和体重指数（BMI）切点是否可以提高使用逻辑回归模型预测糖基化异常的预测能力。
从第一民族和梅蒂斯参与者（n=1479）中收集了一份自我管理的 CANRISK 问卷、人体测量学数据以及标准口服葡萄糖耐量试验（OGTT）的结果。使用已发布的风险评分切点计算了 CANRISK 评分的敏感性和特异性。使用替代的种族特异性 BMI 和 WC 切点进行逻辑回归，使用 CANRISK 变量预测糖基化异常。
与 OGTT 结果相比，在 40 岁或以上的人群中，CANRISK 评分切点为 33 时，CANRISK 的敏感性和特异性分别为 68%和 63%；在 40 岁以下的人群中，分别为 27%和 87%。使用较低的切点 21，40 岁以下人群的敏感性提高到 77%，特异性为 44%。尽管在这个阈值下特异性较低，但较高的敏感性反映了在该人群中识别高风险个体的重要性。尽管 BMI 和 WC 的切点发生了变化，但逻辑回归模型表现出相似的预测能力。
CANRISK 在加拿大第一民族/梅蒂斯人群的广泛年龄范围内作为糖尿病筛查的初步步骤效果良好，对 40 岁以下的个体有调整后的 CANRISK 切点，并且使用替代 BMI/WC 切点没有带来额外的改善。
