title: Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy.
abstract: BACKGROUND
  To investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria.
  
  
  METHODS
  A cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).
  
  
  RESULTS
  Defining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.
  
  
  CONCLUSIONS
  A shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy.
authors: Jordi Gol Primary Care Research Institute, Reus-Tarragona Diabetes Research Group, Catalan Health Institute, Primary Health Care Division, Camí de Riudoms 53-55, 43202, Reus, Spain. costaber@gmail.com
authors: Bernardo
authors: B
authors: Costa
authors: Francisco
authors: F
authors: Barrio
authors: Josep L
authors: JL
authors: Piñol
authors: Joan J
authors: JJ
authors: Cabré
authors: Xavier
authors: X
authors: Mundet
authors: Ramon
authors: R
authors: Sagarra
authors: Jordi
authors: J
authors: Salas-Salvadó
authors: Oriol
authors: O
authors: Solà-Morales
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015510:Clinical Medicine / Q000379:methods; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods; D018570:Risk Assessment
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human