RESEARCH ARTICLE
Diabetes risk score: towards earlier detection of
Type 2 diabetes in general practice
S. J. Grif®n
1
*
P. S. Little
2
C. N. Hales
3
A. L. Kinmonth
1
N. J. Wareham
4
1
General Practice and Primary Care
Research Unit, Department of Public
Health and Primary Care,
Institute of Public Health,
University Forvie Site, Robinson Way,
Cambridge CB2 2SR, UK
2
Primary Medical Care Group,
University of Southampton,
Aldermoor Health Centre,
Aldermoor Close,
Southampton SO16 5ST, UK
3
Department of Clinical Biochemistry,
Addenbrooke's Hospital, Hills Road,
Cambridge CB2 2QR, UK
4
Department of Public Health and
Primary Care, Institute of Public
Health, University Forvie Site,
Robinson Way, Cambridge CB2 2SR,
UK
*Correspondence to: Dr S. J. Grif®n,
Department of Public Health and
Primary Care, Institute of Public
Health, University Forvie Site,
Robinson Way, Cambridge
CB2 2SR, UK.
E-mail: sjg49@medschl.cam.ac.uk
Received: 31 January 2000
Accepted: 2 March 2000
Published online: 16 March 2000
Abstract
Background Type 2 diabetes is common, costly and often goes unrecog-
nised for many years. When patients are diagnosed, the majority exhibit
associated tissue damage or established cardiovascular risk. Evidence is
accumulating that earlier detection and management of diabetes and related
metabolic abnormalities may be bene®cial. We aimed to develop and evaluate
a score based on routinely collected information to identify people at risk of
having undetected diabetes.
Methods A population-based sample of 1077 people, aged 40 to 64 years,
without known diabetes, from a single Cambridgeshire general practice,
underwent clinical assessment including an oral glucose tolerance test. In a
separate 12-month study, 41 practices in southern England reported clinical
details of patients aged 40 to 64 years with newly diagnosed Type 2 diabetes.
A notional population was created by random selection and pooling of half of
each dataset. Data were entered into a regression model to produce a formula
predicting the risk of diabetes. The performance of this risk score in detecting
diabetes was tested in an independent, randomly selected, population-based
sample.
Results Age, gender, body mass index, steroid and antihypertensive
medication, family and smoking history contributed to the score. In the
test population at 72% speci®city, the sensitivity of the score was 77% and
likelihood ratio 2.76. The area under the receiver-operating characteristic
curve was 80%.
Conclusions A simple score, using only data that are routinely collected in
general practice, can help identify those at risk of diabetes. This score could
contribute to ef®cient earlier detection through case-®nding or targeted
screening. Copyright # 2000 John Wiley & Sons, Ltd.
Keywords Type 2 diabetes; risk score; general practice; screening
Introduction
Diabetes is increasingly common [1,2] and creates a substantial burden of
suffering and cost [3]. Diabetes is frequently asymptomatic [4] and although
detection is improving [5], it remains haphazard [6]. Half of those patients
with Type 2 diabetes are undiagnosed [7] and the delay from disease onset to
diagnosis may exceed 10 years [8]. When patients are diagnosed, 25% have
established retinopathy [9], half already have clinical evidence of diabetic
tissue damage [10], and many exhibit additional established cardiovascular
risk factors [7,9,11].
A growing body of evidence suggests that earlier detection and treatment of
hyperglycaemia and related metabolic abnormalities may be bene®cial. The
DIABETES/METABOLISM RESEARCH AND REVIEWS
Diabetes Metab Res Rev 2000; 16: 164±171.
Copyright # 2000 John Wiley & Sons, Ltd.