Open Access 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

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.

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