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- Title
Validation of a Simple Screening Tool for Detecting Undiagnosed Diabetes and Prediabetes.
- Authors
Heikes, Kenneth E.; Schlessinger, Leonard; Arondekar, Bhakti; Eddy, David
- Abstract
Given the increasing prevalence of diabetes and prediabetes, there is a need for developing a simple validated screening tool to identify individuals with undiagnosed diabetes or prediabetes. Our objective was to validate a simple screening tool that calculates the probability that a person has either undiagnosed diabetes or prediabetes using questions known to an average person. Diabetes was defined as either FPG > 126 or OGTT > 200 and prediabetes as no diabetes and either FPG 100-125 or OGTT 140-200. Person-specific data from NHANES 3 were used to build the tool. The tool was built using a classification and regression tree (CART) method, and includes questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history, and exercise. Two methods were used to validate the classification tree. The first used split sample cross-validation method applied to the same data set. The second involved applying the classification tree to the NHANES 1999-2004. NHANES 1999-2004 does not include OGTT and therefore validation using it is biased to underestimate the true prevalence of pre- and undiagnosed diabetes. Using the training data, the accuracy of the tool for undiagnosed diabetes was: sensitivity = 88%, specificity = 75%, positive predictive value (PPV) = 14%, negative predictive value (NPV) = 99.3%, and area under the ROC curve (aROC) = 0.85 and for prediabetes or undiagnosed diabetes was: sensitivity = 75%, specificity = 65%, PPV = 49%, NPV = 85%, and aROC = 0.75. Validation results are in Table I. As expected, the sensitivity, specificity and predictive values are somewhat lower in the independent validations than was calculated for the training datasets, however, it compares favorably to other tools for detecting diabetes. This new and simple tool is an easy and validated tool to screen people who have prediabetes or undiagnosed diabetes.
- Subjects
DIAGNOSIS of diabetes; PREDIABETIC state; GLUCOSE tolerance tests; GESTATIONAL diabetes; ETHNICITY; HYPERTENSION
- Publication
Diabetes, 2007, Vol 56, pA255
- ISSN
0012-1797
- Publication type
Article