A quick self-assessment tool to identify individuals at high risk of type 2 diabetes in the Chinese general population
- 1Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Australia
- 2Department of Epidemiology, Shenzhen University School of Medicine, Shenzhen, Guangdong, PR China
- 3Department of Evidence-Based Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
- 4Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Correspondence to Dr Dongsheng Hu, Department of Epidemiology, Shenzhen University School of Medicine, 3688Nanhai Avenue, Shenzhen, Guangdong 518060, PR China; dongsheng_hu{at}hotmail.com
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Contributors All authors contributed to the paper. JX undertook the analysis and interpreted the results and drafted the paper. DH, DHY, JH, CSC and DFG critically revised the paper. All authors have seen and agreed the final draft. JX is guarantor for the paper.
- Accepted 7 May 2009
- Published Online First 25 August 2009
Abstract
Background Currently available tools for identifying individuals at high risk of type 2 diabetes can be invasive, costly and time consuming. This study aims to develop and validate a self-assessment tool for identifying individuals at high risk of type 2 diabetes in the Chinese general population.
Methods A cross-sectional survey was conducted from 2000 to 2001 in a nationally representative sample of 15 540 Chinese adults aged 35–74 years. The diabetes risk level (DRL) was assessed by classification and regression tree (CART) analysis using four predictors: age, body mass index, waist–hip ratio (WHR) and waist circumference (WC).
Results The significant predictors for type 2 diabetes were WHR and age for women and WC and age for men. The categories generated by CART analysis stratified women into eight DRL and men into five DRL. The prevalence of type 2 diabetes increased with the increase in DRL in both women and men. A DRL of 6 or greater predicted type 2 diabetes status with a sensitivity of 0.61 (95% CI 0.55 to 0.67), a specificity of 0.71 (95% CI 0.70 to 0.73) in women, and a DRL of 3 or greater predicted type 2 diabetes status with a sensitivity of 0.59 (95% CI 0.52 to 0.65) and a specificity of 0.63 (95% CI 0.62 to 0.65) in men.
Conclusions This study demonstrates that application of the DRL has identified a substantial proportion of individuals with type 2 diabetes in the Chinese general population. It suggests that there is a great potential for applying the self-assessment tool in healthcare-limited settings.
- AUC, area under the receiver operating characteristics curve
- CART, classification and regression tree
- DRL, diabetes risk level
- NPV, negative predictive value
- PPV, positive predictive value
- WHR, waist-hip ratio
- WC, waist circumference
Footnotes
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Funding The InterASIA study was funded by a contractual agreement between Tulane University, Los Angeles, USA, and Pfizer Inc, New York, USA. Several researchers employed by Pfizer Inc were members of the study steering committee that designed the study. However, the study was conducted, analysed and interpreted by the investigators independently of the sponsor.
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Competing Interests None.
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Ethics approval The InterASIA study was approved by the Institutional Review Board at the Tulane University Health Sciences Center and the ethics committee and other relevant regulatory bodies in China.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; externally peer reviewed.
