title: Development of a screening score for undiagnosed diabetes and its application in estimating absolute risk of future type 2 diabetes in Japan: Toranomon Hospital Health Management Center Study 10 (TOPICS 10).
abstract: OBJECTIVE
  The objective of the study was to develop a screening score for undiagnosed diabetes by eliciting information on noninvasive clinical markers and to assess its effectiveness for identifying the presence of diabetes and predicting future diabetes.
  
  
  METHODS
  A screening score was cross-sectionally developed for 33 335 Japanese individuals aged 18-88 years without known diabetes who underwent a health examination. We validated its utility and compared it with existing screening tools in an independent population (n = 7477). After initial assessment of the instrument, 7332 nondiabetic individuals were followed up for a mean 4.0 years.
  
  
  RESULTS
  Prevalence of undiagnosed diabetes (fasting plasma glucose ≥ 7.0 mmol/L or glycated hemoglobin ≥ 6.5%) was 2.9% (n = 965). Diabetes score included age, sex, family history of diabetes, current smoking habit, body mass index, and hypertension with an area under the receiver-operating characteristics curve of 0.771. Screening with 8 or more points yielded a sensitivity of 72.7% and a specificity of 68.1%. In the validation cohort, the area under the receiver-operating characteristics curve was 0.806. The developed score with 8 or more points had better positive predictive value (9.6%) and positive likelihood ratio (2.52) compared with existing tools (positive predictive value, from 6.9% to 9.4%; positive likelihood ratio, from 1.77 to 2.46) in which each tool's highest combination of sensitivity and specificity was observed. The 4-year cumulative risk of developing diabetes gradually escalated in association with higher screening scores at the initial examination.
  
  
  CONCLUSIONS
  Our algorithm could serve as a self-assessment tool for undiagnosed diabetic patients needing timely medical care and as a prognostic tool for individuals without present diabetes who must be closely followed up to prevent future diabetes.
authors: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata 951-8510, Japan.
authors: Yoriko
authors: Y
authors: Heianza
authors: Yasuji
authors: Y
authors: Arase
authors: Kazumi
authors: K
authors: Saito
authors: Shiun Dong
authors: SD
authors: Hsieh
authors: Hiroshi
authors: H
authors: Tsuji
authors: Satoru
authors: S
authors: Kodama
authors: Shiro
authors: S
authors: Tanaka
authors: Yasuo
authors: Y
authors: Ohashi
authors: Hitoshi
authors: H
authors: Shimano
authors: Nobuhiro
authors: N
authors: Yamada
authors: Shigeko
authors: S
authors: Hara
authors: Hirohito
authors: H
authors: Sone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D055815:Young Adult