title: Comparison of screening scores for diabetes and prediabetes.
abstract: OBJECTIVE
  There are numerous risk or screening scores for the prediction of type-2 diabetes mellitus (DM). In contrast, few scores are available for preDM. In this paper, we compare the two screening scores from the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) that can be used for DM as well as preDM.
  
  
  METHODS
  Adult participants (N=9391) without known DM from the National Health and Nutrition Examination Surveys 2009-12 were included. We fitted the factors/items in the ADA and CDC scores in logistic regression with the outcomes of undiagnosed DM, preDM, and combination, and assessed the association and discrimination accuracy. We also evaluated the suggested cutpoints that define high risk individuals. We mimicked the original models/settings but also tested various deviations/modifications often encountered in practice.
  
  
  RESULTS
  Both scores performed well and robustly, while the ADA score performed somewhat better (e.g., AUC=0.77 for ADA and 0.73-0.74 for CDC for DM; 0.72-0.74 and 0.70-0.71 for preDM). The same predictors and scoring rules seem to be reasonably justified with different cutpoints for DM and preDM, which can make usage easier and consistent. Some factors such as race and HDL/LDL cholesterols may be useful additions to health education.
  
  
  CONCLUSIONS
  Current DM education and screening focus on the prevention and management of DM. The ADA and CDC scores could further help when we identify individuals at high risk for preDM, and teach the importance of preDM during which lifestyle intervention can be effective and urgently needed.
authors.affiliation: Graduate Group in Epidemiology, University of California, Davis, USA.
authors.forename: Eduard
authors.initials: E
authors.lastname: Poltavskiy
authors.affiliation: Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea.
authors.forename: Dae Jung
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Graduate Group in Epidemiology, University of California, Davis, USA; Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, USA. Electronic address: hbang@ucdavis.edu.
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009749:Nutrition Surveys; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012307:Risk Factors; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: ADA; CDC; Prediabetes; Risk assessment; Risk score; Screening