Improvements in ability to detect undiagnosed diabetes by using information on family history among adults in the United States.
Family history is an independent risk factor for diabetes, but it is not clear how much adding family history to other known risk factors would improve detection of undiagnosed diabetes in a population. Using the National Health and Nutrition Examination Survey for 1999-2004, the authors compared logistic regression models with established risk factors (model 1) with a model (model 2) that also included familial risk of diabetes (average, moderate, and high). Adjusted odds ratios for undiagnosed diabetes, using average familial risk as referent, were 1.7 (95% confidence interval (CI): 1.2, 2.5) and 3.8 (95% CI: 2.2, 6.3) for those with moderate and high familial risk, respectively. Model 2 was superior to model 1 in detecting undiagnosed diabetes, as reflected by several significant improvements, including weighted C statistics of 0.826 versus 0.842 (bootstrap P = 0.001) and integrated discrimination improvement of 0.012 (95% CI: 0.004, 0.030). With a risk threshold of 7.3% (sensitivity of 40% based on model 1), adding family history would identify an additional 620,000 (95% CI: 221,100, 1,020,000) cases without a significant change in false-positive fraction. Study findings suggest that adding family history of diabetes can provide significant improvements in detecting undiagnosed diabetes in the US population. Further research is needed to validate the authors' findings.
Yang
Quanhe
Q
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. qay0@cdc.gov
Liu
Tiebin
T
Valdez
Rodolfo
R
Moonesinghe
Ramal
R
Khoury
Muin J
MJ
D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D012372:ROC Curve; D012307:Risk Factors; D014481:United States / Q000453:epidemiology