Division of Endocrinology and Metabolism, West China Hospital, Sichuan University , Chengdu, China.
Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University , Xi'an, China.
Postgrad Med. 2020 Nov;132(8):737-745. doi: 10.1080/00325481.2020.1821234. Epub 2020 Sep 29.
To evaluate the performance and cost-effectiveness of existing diabetes risk scores (DRSs) to screen for undiagnosed diabetes mellitus (UDM) and prediabetes (PD) in a community-based southwestern Chinese population.
Participants in TIDE-Chengdu survey with requisite data and without known diabetes were included. Five Chinese-derived DRSs and six non-Chinese-derived DRSs were included for evaluation. Their performance in detecting UDM and UMD or PD (UDM/PD) was assessed using the C-statistic. The cost-effectiveness of the optimal DRS was compared with that of capillary fasting blood glucose (CFBG).
Of the 1,692 TIDE-Chengdu survey participants included, 177 (10.5%) had UDM and 339 (20.0%) had PD. The rural participants (N = 737) were more likely to have UDM (13.4% . 8.2%) and PD (24.8% . 16.3%) than their urban counterparts (N = 955) (0.0001). In the full population, the included DRSs all showed good discrimination in detecting UDM (C-statistic: 0.699 to 0.762) and UDM/PD (C-statistic: 0.717 to 0.769), but the New Chinese DRS (NCDRS) performed best for both UDM and UDM/PD. The DRSs evaluated all showed better performance in urban participants than rural participants for both UDM (C-statistic: 0.718 to 0.795 . 0.642 to 0.720) and UDM/PD (C-statistic: 0.729 to 0.793 . 0.682 to 0.726) (all 0.05). The mean cost per UDM/PD case identified was lower with NCDRS at score 25 (¥503.3($71.9)) and 27 (¥490.5 ($70.1)) than CFBG at 5.0, 5.1, 5.2, or 5.3 mmol/L (¥631.7 ($90.2), ¥611.8 ($87.4), ¥579.2 ($82.7) and ¥551.9 ($78.8)), whereas the mean costs per UDM case identified was higher with NCDRS at score 25 (¥1379.3 ($197.0)) and 27 (¥1315.1 ($187.9)) than CFBG at 5.3, 5.4, or 5.5 mmol/L (¥1301.7 ($186.0), ¥1247.7 ($178.2) and ¥1173.3 ($167.6)).
The NCDRS represents a valid and cost-effective tool for use in southwestern China to identify high-risk patients with UDM or PD who need a diagnostic test.
评估现有的糖尿病风险评分（DRS）在西南地区汉族人群中筛查未确诊的糖尿病（UDM）和糖尿病前期（PD）的性能和成本效益。
纳入 TIDE-Chengdu 调查中具有必要数据且无已知糖尿病的参与者。纳入了五种源自中国的 DRS 和六种非源自中国的 DRS 进行评估。使用 C 统计量评估它们检测 UDM 和 UDM 或 PD（UDM/PD）的性能。将最佳 DRS 的成本效益与毛细血管空腹血糖（CFBG）进行比较。
在纳入的 1692 名 TIDE-Chengdu 调查参与者中，有 177 名（10.5%）患有 UDM，339 名（20.0%）患有 PD。农村参与者（N=737）比城市参与者（N=955）更有可能患有 UDM（13.4%比 8.2%）和 PD（24.8%比 16.3%）（P<0.0001）。在全人群中，所纳入的 DRS 均在检测 UDM（C 统计量：0.699 至 0.762）和 UDM/PD（C 统计量：0.717 至 0.769）方面表现出良好的区分度，但新的中国 DRS（NCDRS）在检测 UDM 和 UDM/PD 方面的表现最佳。对于 UDM（C 统计量：0.718 至 0.795，0.642 至 0.720）和 UDM/PD（C 统计量：0.729 至 0.793，0.682 至 0.726），所评估的 DRS 在城市参与者中的表现均优于农村参与者（均 P<0.05）。与 CFBG 在 5.0、5.1、5.2 或 5.3 mmol/L 时相比，NCDRS 在评分 25（¥503.3（$71.9））和 27（¥490.5（$70.1））时检测 UDM/PD 病例的平均成本更低，而与 CFBG 在 5.3、5.4 或 5.5 mmol/L 时相比，NCDRS 在评分 25（¥1379.3（$197.0））和 27（¥1315.1（$187.9））时检测 UDM 病例的平均成本更高。
NCDRS 是一种在西南地区有效且具有成本效益的工具，可用于识别需要诊断性检查的 UDM 或 PD 高危患者。
