Type 2 diabetes mellitus in midlife estimated from the Cambridge Risk Score and body mass index.
BACKGROUND
The Cambridge Risk Score (CRS) was developed to screen for type 2 diabetes mellitus risk. We assessed the ability of the CRS to predict glycosylated hemoglobin (HbA(1c)) levels and determined whether the CRS was better than body mass index (BMI) at predicting HbA(1c) levels in midlife.


METHODS
We included 7452 participants without known diabetes in a biomedical survey of the 1958 British Birth Cohort at 45 years of age. Receiver operator characteristic curves were used to compare the ability of the CRS and BMI to identify individuals with elevated HbA(1c) levels using thresholds of 7.0% or more, 6.0% or more, and 5.5% or more.


RESULTS
Of the total sample, 0.9% (95% confidence interval [CI], 0.7%-1.1%) had HbA(1c) levels of 7.0% or more; 3.8% (95% CI, 3.2%-4.5%), 6.0% or more; and 24.4% (95% CI, 23.1%-25.9%), 5.5% or more. The CRS detected individuals with elevated HbA(1c) levels with reasonable accuracy (area under the curve, 0.84 for HbA(1c) level >or=7.0%; 0.76 for HbA(1c) level >or=6.0%). Similar area under the curve values were obtained using BMI alone (0.84 for HbA(1c) level >or=7.0%; 0.79 for HbA(1c) level >or=6.0%). When tested using the lower HbA(1c) threshold of 5.5% or more, the CRS and BMI did not perform well (areas under the curve, 0.65 and 0.63 for CRS and BMI, respectively). Both measures indicated that approximately 20% of the cohort were at increased risk of diabetes. Owing to the low prevalence of diabetes at 45 years of age, only 2% to 3% of those considered at risk had elevated HbA(1c) levels.


CONCLUSIONS
For a population in mid-adult life, the CRS identified individuals with elevated HbA(1c) levels reasonably well. However, the CRS had no advantage compared with BMI alone in identifying diabetes risk.
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, England. c.thomas@ich.ucl.ac.uk
Claudia
C
Thomas
Elina
E
Hyppönen
Chris
C
Power
D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology
D006442:Glycated Hemoglobin