Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada; Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Can J Diabetes. 2020 Jul;44(5):379-386.e3. doi: 10.1016/j.jcjd.2019.11.002. Epub 2019 Dec 5.
The Canadian prevalence and incidence of diabetes has increased by the greatest extent in young adulthood. The original Canadian Diabetes Risk Questionnaire (CANRISK) was created to assess dysglycemia risk among adults ≥40 years of age, but it has not been validated among younger adults. Furthermore, it is unclear whether a young adult-specific risk score would better identify dysglycemia in this age group.
Analyses were done on participants who completed the self-administered CANRISK and underwent anthropometric and blood glucose measurements, were 18 to 39 years of age, were not pregnant and had no previous diabetes diagnosis. A risk model was generated from a lenient stepwise function fit with predictors identified through univariate analyses. Risk scores were produced from adjusted odds ratios. Model performance was internally validated using bootstrap methods and compared with the original CANRISK prognostic tool.
Of the 3,334 participants included in the study, 194 (5.8%) and 51 (1.5%) were living with prediabetes or undiagnosed diabetes, respectively. The model displayed an area under the curve of 73.0%, adjusted to 72.9% after bootstrapping; however, using the original CANRISK model resulted in similar results (area under the curve, 71.4%). Sensitivity and specificity of the new and original models were also comparable (78.8% vs 77.1% and 54.0% vs 55.0%, respectively).
The original CANRISK score performed well among young adults, even when compared with a young adult-specific model. We suggest that the cut point be lowered for young adults and the tool be permitted for use in this age group.
在所有年龄段中，加拿大成年人糖尿病的患病率和发病率增长幅度最大。最初的加拿大糖尿病风险问卷（CANRISK）是为评估≥40 岁成年人的血糖异常风险而创建的，但尚未在年轻成年人中进行验证。此外，尚不清楚年轻成年人特异性风险评分是否能更好地识别该年龄段的血糖异常。
对完成自我管理的 CANRISK 问卷调查且接受了人体测量和血糖测量、年龄在 18 至 39 岁之间、未怀孕且无先前糖尿病诊断的参与者进行了分析。使用宽松的逐步函数生成风险模型，通过单变量分析确定预测因子。通过调整后的优势比生成风险评分。使用自举方法对内部分数模型进行验证，并与原始 CANRISK 预测工具进行比较。
在纳入研究的 3334 名参与者中，194 名（5.8%）和 51 名（1.5%）分别患有前期糖尿病或未确诊的糖尿病。该模型的曲线下面积为 73.0%，经过自举后调整为 72.9%；然而，使用原始 CANRISK 模型得到的结果相似（曲线下面积为 71.4%）。新模型和原始模型的敏感性和特异性也相当（分别为 78.8%比 77.1%和 54.0%比 55.0%）。
即使与年轻成年人特异性模型相比，原始 CANRISK 评分在年轻成年人中表现良好。我们建议将年轻成年人的切点降低，并允许在该年龄段使用该工具。
