Detection of impaired glucose regulation and/or type 2 diabetes mellitus, using primary care electronic data, in a multiethnic UK community setting.
OBJECTIVE
The aim of this study was to develop and validate a score for detecting the glycaemic categories of impaired glucose regulation (IGR) and type 2 diabetes using the WHO 2011 diagnostic criteria.


METHODS
We used data from 6,390 individuals aged 40-75 years from a multiethnic population based screening study. We developed a logistic regression model for predicting IGR and type 2 diabetes (diagnosed using OGTT or HbA(1c) ≥ 6.5% [48 mmol/mol]) from data which are routinely stored in primary care. We developed the score by summing the β coefficients. We externally validated the score using data from 3,225 participants aged 40-75 years screened as part of another study.


RESULTS
The score includes age, ethnicity, sex, family history of diabetes, antihypertensive therapy and BMI. Fifty per cent of a population would need to be invited for testing to detect type 2 diabetes mellitus on OGTT with 80% sensitivity; this is slightly raised to 54% that need to be invited if using HbA(1c). Inviting the top 10% for testing, 9% of these would have type 2 diabetes mellitus using an OGTT (positive predictive value [PPV] 8.9% [95% CI 5.8%,12.8%]), 26% would have IGR (PPV 25.9% [95% CI 20.9%, 31.4%]). Using HbA(1c) increases the PPV to 19% for type 2 diabetes mellitus (PPV 18.6% [95% CI 14.2%, 23.7%]) and 28% for an HbA(1c) between 6.0% and 6.4% (PPV 28.3% [95% CI 23.1%, 34.0%]).


CONCLUSIONS
The score can be used to reliably identify those with undiagnosed IGR and type 2 diabetes in multiethnic populations. This is the first score developed taking into account HbA(1c) in the diagnosis of type 2 diabetes.
Department of Health Sciences, University of Leicester, Leicester, UK. lg48@le.ac.uk
L J
LJ
Gray
M J
MJ
Davies
S
S
Hiles
N A
NA
Taub
D R
DR
Webb
B T
BT
Srinivasan
K
K
Khunti
D000328:Adult; D000368:Aged; D001786:Blood Glucose; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D057286:Electronic Health Records; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D006113:United Kingdom
D001786:Blood Glucose; D006442:Glycated Hemoglobin