Table 1.
Diabetes Risk Scores Developed in Populations Sampled Primarily From the General Population and Validated in External Populationsa
| First Author, Year (Reference No.) | Population, Country | Variables Included in the Risk Scoreb | Discriminationc |
| Atherosclerosis Risk in Communities Study Diabetes Risk Score, United States | |||
| Schmidt, 2005 (52) | Atherosclerosis Risk in Communities study, United States | Clinical model: age, ethnicity, parental history, systolic BP, WC, height | 0.71 |
| Clinical model + fasting glucose | 0.78 | ||
| Clinical model + fasting glucose, triglycerides, HDL cholesterol | 0.80 | ||
| Metabolic syndrome National Cholesterol Education Program–Third Adult Treatment Panel definition (1 point for each high WC, high triglycerides, low HDL cholesterol, high BP/antihypertensive use, high fasting glucose) | 0.75 | ||
| Augmented metabolic syndrome (1 point for each high WC, high triglycerides, low HDL cholesterol, high BP/antihypertensive use; 2 points for fasting glucose ≥5.6 mmol/L or 5 points for fasting glucose ≥6.1 mmol/L); 1 point for BMI ≥30 kg/m2) | 0.78 | ||
| Validation in external populations: | |||
| Mainous, 2007 (56) | Coronary Artery Risk in Young Adults, United States | Augmented metabolic syndrome: WC, triglycerides, HDL cholesterol, hypertension, fasting glucose, BMI (6/6) | 0.70 |
| Stern, 2008 (57) | San Antonio Heart Study,United States | Not reported in detail | 0.870 |
| Sun, 2009 (58) | MJ Longitudinal health-check-up-based Population Database, Taiwan | Age, ethnicity, family history, fasting glucose, systolic BP, WC, height (7/7) | 0.84 |
| Age, ethnicity, family history, fasting glucose, systolic BP, WC, height, triglycerides, HDL cholesterol (9/9) | 0.84 | ||
| Sun, 2009 (58) | MJ Longitudinal health-check-up-based Population Database, Taiwan | Age, ethnicity, family history, fasting glucose, systolic BP, WC, height (7/7) | 0.83 |
| Age, ethnicity, family history, fasting glucose, systolic BP, WC, height, triglycerides, HDL cholesterol (9/9) | 0.83 | ||
| Cambridge Diabetes Risk Score, United Kingdom | |||
| Griffin, 2000 (46) | Population from general practices, United Kingdom | Model for predicting undiagnosed diabetes: age, sex, BMI, smoking status, corticosteroid use, antihypertensive use, family history | Independent sample: 0.80 |
| Validation in external populations: | |||
| Simmons, 2007 (59) | EPIC-Norfolk, United Kingdom | Age, sex, prescribed antihypertensive medication, prescribed steroids, BMI, family history of diabetes, smoking (7/7) | 0.76 |
| Rahman, 2008 (60) | EPIC-Norfolk, United Kingdom | Age, sex, family history, smoking, prescribed antihypertensive medication, prescribed steroids, BMI (7/7) | 0.745 |
| Chien, 2009 (61) | Cohort, China | Not reported | 0.581 |
| Hippisley-Cox, 2009 (62) | Cohort from general practices, United Kingdom | Age, sex, BMI, smoking status, corticosteroid use, antihypertensive use, family history (7/7) | Men: 0.801; women: 0.813 |
| Data From an Epidemiological Study on the Insulin Resistance Syndrome Diabetes Risk Score, France (55) | |||
| Balkau, 2008 (55) | Data from an Epidemiological Study on the Insulin Resistance syndrome, France | Men: Clinical prediction model—current smoking, WC, hypertension | 0.733 |
| Men: Clinical and biologic model—current smoking, WC, fasting glucose, fasting glucose squared, gamma-glutamyltransferase | 0.850 | ||
| Men: above variables + risk alleles for transcription factor 7-like 2 and interleukin 6 | 0.851 | ||
| Men: Integer clinical risk score of WC, current smoking, hypertension | 0.713 | ||
| Women: Clinical prediction model—family history, WC, hypertension | 0.839 | ||
| Women: Clinical and biologic model—family history, BMI, fasting glucose, fasting glucose squared, triglycerides | 0.917 | ||
| Women: above variables + risk alleles for transcription factor 7-like 2 and interleukin 6 | 0.912 | ||
| Women: integer clinical risk score of WC, family history, hypertension | 0.827 | ||
| Validation in external populations: | |||
| Kahn, 2009 (63) | Atherosclerosis Risk in Communities study, United States | WC, hypertension, current smoker (men), family history (women) (3/3) | 0.66 |
| Finnish Diabetes Risk Score, Finland (51) | |||
| Lindström, 2003 (51) | FINRISK, Finland | Concise model: age, BMI, WC, history of antihypertensive use, previous diabetes | 0.857 |
| Full model: concise model + physical inactivity, fruit and vegetable intake | 0.860 | ||
| Score model: age, BMI, WC, antihypertensive use, previous diabetes, physical activity, fruit and vegetables intake | 0.852 | ||
| Validation in external populations: | |||
| Lindström, 2003 (51) | FINRISK, Finland | Full model: age, BMI, WC, antihypertensive use, previous diabetes, physical activity, fruit and vegetables intake (7/7) | 0.87 |
| Alssema, 2008 (64) | Hoorn Study, the Netherlands | Concise model: age, BMI, WC, antihypertensive medication, previous diabetes, family history (6/5); an extra age category of ≥65 years created and includes family history | 0.71 |
| Alssema, 2008 (64) | Prevention of renal and vascular end-stage disease study, the Netherlands | Concise model: age, BMI, WC, antihypertensive medication, previous diabetes, family history (6/5); an extra age category of ≥65 years created and includes family history | 0.77 |
| Alssema, 2008 (64) | Monitoring Project on Chronic Disease Risk Factors Study, the Netherlands | Concise model: age, BMI, WC, antihypertensive medication, previous diabetes, family history (6/5); an extra age category of ≥65 years created and includes family history | 0.71 |
| Balkau, 2008 (55) | Data from an Epidemiological Study on the Insulin Resistance syndrome, France | Full model: age, BMI, WC, antihypertensive medication, physical activity (5/7); excludes previous diabetes and diet | Men: 0.678; women: 0.809 |
| Cameron, 2008 (65) | Australian Diabetes, Obesity and Lifestyle Study, Australia | Deviations from the full original score: includes parental history, activity excludes occupational activity | 0.727 |
| Abdul-Ghani, 2009 (66) | Botnia Study, Finland | Concise model: age, BMI, WC, use of hypertensive medications, family history (5/5); excludes prevalent diabetes, includes family history | 0.646 |
| Framingham Offspring Diabetes Risk Score, United States | |||
| Wilson, 2007 (54) | Framingham Offspring Study, United States | Personal model: age, sex, parental history, BMI | 0.724 |
| Simple clinical model with categorical variables: age, sex, parental history, BMI, WC, fasting glucose, HDL cholesterol, triglycerides, hypertension | 0.852 (repeated random samples: 0.73–0.91) | ||
| Simple point score system: parental history, BMI, fasting glucose, HDL cholesterol, triglycerides, hypertension | 0.850 | ||
| Simple clinical model with continuous variables: age, sex, parental history, BMI, systolic BP, WC, fasting glucose, HDL cholesterol, triglycerides | 0.881 | ||
| Complex clinical model: age, sex, parental history, BMI, WC, fasting glucose, HDL cholesterol, triglyceride, hypertension, 2-hour glucose, fasting insulin, C-reactive protein | 0.854 | ||
| Best biologic model: complex clinical model + hormone therapy, current smoking, alcohol intake, aspirin or nonsteroidal antiinflammatory drug use, glycated hemoglobin, homeostatic model assessment of insulin resistance, Gutt insulin sensitivity index, homeostatic model assessment beta-cell index | 0.869 | ||
| Validation in external populations: | |||
| Li, 2007 (67) | Cohort, Germany | Reestimated simple clinical model: age, sex, family history, BMI, hypertension, HDL cholesterol, triglycerides, fasting glucose (8/9); excludes WC | 0.86 (validated: 0.828) |
| Lyssenko, 2008 (68) | Malmö Preventive Project, Sweden | Personal model: age, sex, family history, BMI (4/4) | Categorical 0.69; continuous 0.707 |
| Simple clinical model with categorical variables: age, sex, family history, BMI, BP, triglycerides, fasting glucose (7/9); excludes WC, HDL cholesterol | Categorical 0.729; continuous: 0.743 | ||
| Lyssenko, 2008 (68) | Botnia Study, Finland | Personal model: age, sex, family history, BMI (4/4) | Categorical: 0.736; continuous: 0.769 |
| Simple clinical model with categorical variables: age, sex, family history, BMI, BP, triglycerides, fasting glucose (7/9); excludes WC, HDL cholesterol | Categorical: 0.755; continuous: 0.786 | ||
| Nichols, 2008 (69) | Kaiser Permanente Northwest, United States | Family history used as proxy for parental history | |
| Personal model: age, sex, parental history, BMI (4/4); reestimated | 0.676 | ||
| Simple clinical model with categorical variables: age, sex, parental history, BMI, fasting glucose, HDL cholesterol, triglycerides, hypertension (8/9); reestimated model excludes WC | 0.824 | ||
| Simple clinical model with continuous variables: age, sex, parental history, BMI, fasting glucose, HDL cholesterol, triglycerides, hypertension (8/9); reestimated model excludes WC | 0.840 | ||
| Simple point score system: parental history, BMI, fasting glucose, HDL cholesterol, triglycerides, hypertension (6/6) | Not reported | ||
| Chien, 2009 (61) | Cohort, China | Not reported | 0.662 |
| Kahn, 2009 (63) | Atherosclerosis Risk in Communities study, United States | Simple point score: fasting glucose, BMI, HDL cholesterol, parental diabetes, triglycerides, hypertension (6/6) | 0.76 |
| German Diabetes Risk Score, Germany | |||
| Schulze, 2007 (53, 99) | EPIC-Potsdam, Germany | Full model: age, WC, height, hypertension, physical activity, smoking, and consumption of whole-grain bread, red meat, coffee, moderate alcohol | 0.84 |
| Simplified model with categorical variables: age, WC, height, hypertension, physical activity, smoking, and consumption of whole-grain bread, red meat, coffee, moderate alcohol | 0.83 | ||
| Validation in external populations: | |||
| Schulze, 2007 (53) | EPIC-Heidelberg, Germany | Full model: age, WC, height, hypertension, physical activity, smoking, and consumption of whole-grain bread, red meat, coffee, moderate alcohol (10/10) | 0.82 |
| Indian Diabetes Risk Score, India | |||
| Mohan, 2005 (48) | Chennai Urban Rural Epidemiology Study, India | Model for predicting undiagnosed diabetes: age, WC, family history, physical activity | 0.698 |
| Validation in external populations: | |||
| Mohan, 2008 (70) | Chennai Urban Population Study, India | Age, WC, family history, physical activity (4/4) | Not reported |
| Prospective Cardiovascular Münster Diabetes Risk Score, Germany (49) | |||
| von Eckardstein, 2000 (49) | Prospective Cardiovascular Münster Study, Germany | Age, BMI, fasting glucose, HDL cholesterol, family history, hypertension | 0.793 |
| Validation in external populations: | |||
| Chien, 2009 (61) | Cohort, China | Not reported | 0.631 |
| Rancho Bernardo Diabetes Risk Score, United States | |||
| Kanaya, 2005 (47) | Rancho Bernardo Study, United States | Model for predicting persons with 2-hour glucose ≥140 mg/dL: sex, age ≥70 years, triglycerides ≥150 mg/dL, fasting glucose | Continuous: 0.73; categorical: 0.71; score points: 0.70 |
| Validation in external populations: | |||
| Kanaya, 2005 (47) | Health, Aging and Body Composition Study, United States | Sex, age, triglycerides, fasting glucose (4/4) | 0.71 |
| Abdul-Ghani, 2009 (66) | Botnia Study, Finland | Sex, age, triglycerides, fasting glucose (4/4) | 0.74 |
| San Antonio Diabetes Risk Score, United States | |||
| Stern, 2002 (50) | San Antonio Heart Study, United States | Clinical model: age, sex, ethnicity, BMI, family history, systolic BP, HDL cholesterol, fasting glucose | 0.84 |
| + 2-hour glucose | 0.85 | ||
| Full model: age, sex, ethnicity, BMI, family history, systolic BP, diastolic BP, HDL cholesterol, fasting glucose, total cholesterol, low density lipoprotein cholesterol, triglycerides | 0.85 | ||
| + 2-hour glucose | 0.86 | ||
| Validation in external populations: | |||
| McNeely, 2003 (71) | Japanese American Community Diabetes Study, United States | Clinical model with original weights: age, sex, ethnicity, fasting glucose, systolic BP, HDL cholesterol, BMI, family history (8/8) | After 5–6 years: 0.755; after 10 years: 0.790 |
| Reestimated clinical model: age, sex, ethnicity, fasting glucose, systolic BP, HDL cholesterol, BMI, family history (8/8) | After 5–6 years: 0.789; after 10 years: 0.807 | ||
| Hanley, 2004 (72) | Insulin Resistance Atherosclerosis Study, United States | Age, sex, fasting glucose, systolic BP, HDL cholesterol, BMI, parental or sibling history of diabetes, ethnicity and clinical site (9/8); weighting not reported | 0.785 |
| Stern, 2004 (73) | Mexico City Diabetes Study, Mexico | Not reported in detail | 0.765 |
| San Antonio model with metabolic syndrome (National Cholesterol Education Program-Third Adult Treatment Panel definition: ≥3 of the following—high WC, high triglycerides, low HDL cholesterol, high BP/antihypertensive use, high fasting glucose) | 0.768 | ||
| Cameron, 2007 (74) | Mauritius Study, Republic of Mauritius | Not reported in detail | Graphic display |
| Cameron, 2008 (65) | Australian Diabetes, Obesity and Lifestyle Study, Australia | Reestimated clinical model (71): age, sex, ethnicity, fasting glucose, systolic BP, HDL cholesterol, BMI, family history (8/8); family history includes parental history only | 0.783 |
| Abdul-Ghani, 2009 (66) | Botnia Study, Finland | Age, sex, ethnicity, BMI, BP, fasting glucose, triglycerides, HDL cholesterol (8/8) | 0.743 |
| Chien, 2009 (61) | Cohort, China | Not reported | 0.675 |
Abbreviations: BMI, body mass index; BP, blood pressure; EPIC, European Prospective Investigation into Cancer and Nutrition; HDL, high density lipoprotein; WC, waist circumference.
a
Ordered by risk score.
b
Values in parentheses indicate number/total number of original variables in the validations.
c
Area under the receiver operating characteristic curve.