Open Access Open Badges Research article

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

Bernardo Costa1*, Francisco Barrio1, Josep L Piñol1, Joan J Cabré1, Xavier Mundet1, Ramon Sagarra1, Jordi Salas-Salvadó23, Oriol Solà-Morales4 and the DE-PLAN-CAT/PREDICE Research Group

Author affiliations

1 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

2 Human Nutrition Unit, Faculty of Medicine and Health Sciences, Pere Virgili Health Research Institute. Rovira i Virgili University, Sant Llorenç 21, 43201, Reus, Spain

3 CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain

4 Pere Virgili Health Research Institute. Health Institute Technology Transfer, Tarragona-Barcelona, Sant Llorenç 21, 43201, Reus, Spain

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Citation and License

BMC Medicine 2013, 11:45  doi:10.1186/1741-7015-11-45

Published: 21 February 2013



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.


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).


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.


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.

Type 2 diabetes; screening; impaired fasting glucose; impaired glucose tolerance; pre-diabetes; FINDRISC; primary healthcare