title: A novel testing model for opportunistic screening of pre-diabetes and diabetes among U.S. adults.
abstract: OBJECTIVE
  The study aim was to evaluate the performance of a novel simultaneous testing model, based on the Finnish Diabetes Risk Score (FINDRISC) and HbA1c, in detecting undiagnosed diabetes and pre-diabetes in Americans.
  
  
  METHODS
  This cross-sectional analysis included 3,886 men and women (≥ 20 years) without known diabetes from the U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2010. The FINDRISC was developed based on eight variables (age, BMI, waist circumference, use of antihypertensive drug, history of high blood glucose, family history of diabetes, daily physical activity and fruit & vegetable intake). The sensitivity, specificity, and the receiver operating characteristic (ROC) curve of the testing model were calculated for undiagnosed diabetes and pre-diabetes, determined by oral glucose tolerance test (OGTT).
  
  
  RESULTS
  The prevalence of undiagnosed diabetes was 7.0% and 43.1% for pre-diabetes (27.7% for isolated impaired fasting glucose (IFG), 5.1% for impaired glucose tolerance (IGT), and 10.3% for having both IFG and IGT). The sensitivity and specificity of using the HbA1c alone was 24.2% and 99.6% for diabetes (cutoff of ≥6.5%), and 35.2% and 86.4% for pre-diabetes (cutoff of ≥5.7%). The sensitivity and specificity of using the FINDRISC alone (cutoff of ≥9) was 79.1% and 48.6% for diabetes and 60.2% and 61.4% for pre-diabetes. Using the simultaneous testing model with a combination of FINDRISC and HbA1c improved the sensitivity to 84.2% for diabetes and 74.2% for pre-diabetes. The specificity for the simultaneous testing model was 48.4% of diabetes and 53.0% for pre-diabetes.
  
  
  CONCLUSIONS
  This simultaneous testing model is a practical and valid tool in diabetes screening in the general U.S. population.
authors: The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors: Yurong
authors: Y
authors: Zhang
authors: Pennington Biomedical Research Center, Baton Rouge, LA, United States of America.
authors: Gang
authors: G
authors: Hu
authors: Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America.
authors: Lu
authors: L
authors: Zhang
authors: Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America.
authors: Rachel
authors: R
authors: Mayo
authors: Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America.
authors: Liwei
authors: L
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D009749:Nutrition Surveys; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human