Use of clinical scores to detect dysglycaemia in overweight or obese women.
OBJECTIVE
To test if the use of either HbA(1c) level or calculated clinical scores including two published scores and a new score (the Bondy score) could help in selecting overweight or obese women who should benefit from oral glucose tolerance test (OGTT) to detect dysglycaemia.


METHODS
The French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) score and the Finnish Diabetes risk score (Findrisk) were calculated, whereas the Bondy score was built in a development sample of 698 women, BMI 37±7 kg/m(2), without known diabetes. External validation was performed in a validation sample of 212 women.


RESULTS
A dysglycaemia (according to OGTT results, WHO criteria) was diagnosed in 161 (23.1%) patients. Sensitivity of fasting plasma glucose (FPG)≥6.1 mmol/l and HbA(1c)≥6% to identify dysglycaemia were respectively 27 and 41%. Areas under Receiver Operator Curve (AROC) of HbA(1c), DESIR score and Findrisk to detect dysglycaemia were 0.630 [95% confidence interval 0.580-0.680], 0.606 [0.561-0.652] and 0.635 [0.588-0.683], respectively. The Bondy score, based on age and waist circumference, had a better AROC (0.674 [0.626-0.721]) than the DESIR score (P<0.05). These performances were confirmed in the validation sample. Performing OGTT only in subjects with a Bondy score≥4 (41% of the sample) had a sensitivity of 61% and a better net benefit (0.128) than measuring FPG in all subjects (0.069).


CONCLUSIONS
Performing OGTT in obese women selected on a simple clinical score is more sensitive to identify dysglycaemia than measuring FPG in all of them and may be cost-effective.
Department of Endocrinology-Diabetology-Nutrition, Jean-Verdier Hospital, AP-HP, avenue-du-14-juillet, 93143 Bondy cedex, France.
E
E
Cosson
S
S
Chiheb
E
E
Hamo-Tchatchouang
M-T
MT
Nguyen
M
M
Aout
I
I
Banu
C
C
Pillegand
E
E
Vicaut
P
P
Valensi
D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D005215:Fasting; D005260:Female; D005602:France / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000453:epidemiology; D007333:Insulin Resistance; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis; D050177:Overweight / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055105:Waist Circumference
D001786:Blood Glucose