Indian Diabetes Risk Score: Use beyond population screening for diabetes

I read with interest the article titled “Performance of Indian Diabetes Risk Score (IDRS) as screening tool for diabetes in an urban slum” by Dudeja et al. published in Med J Armed Forces India 2017 April 30;73(2):123–128¹ and would like to compliment the authors for validating a cost effective and non-invasive screening tool for diabetes. As per WHO report, over 19% of the world's diabetic population resides in India. This means that currently India has 35 million diabetic subjects, the number of which is projected to rise to 80 million by the year 2030. The problem becomes grave with the fact that more than half of the individuals with diabetes in India remain undiagnosed and hence are at increased risk of developing diabetic complications. Thus, timely screening and appropriate intervention is the need of the hour.

Opportunistic screening for diabetes is recommended by ADA in routine clinical practice. There is evidence supporting cost effectiveness and validity for the use of diabetes risk score as an alternative to fasting blood sugar for initial screening for diabetes in clinical practice.² In health care settings, the high-risk individuals can be identified using IDRS and be targeted for annual screening for diabetes. Also, by systematic counselling and intervention, it can be used as an efficient tool to reduce the risk in diabetics. The results of a study favoured the Madras Diabetes Research Foundation (MDRS)-IDRS for efficiency and cost effectiveness in comparison to genotyping or OGTT for initial screening for diabetes when used on the whole population.³

Madras Diabetes Research Foundation, Chennai came up with IDRS as a simple and non-invasive tool to help in preliminary screening for Type 2 Diabetes Mellitus (T2DM) in the community. The developers of IDRS have explored its use in many other clinical and epidemiological settings.³ Presently, normoglycemic individuals with a high IDRS score are likely to develop pre-diabetes or diabetes in future. However, among the symptomatic individuals a high IDRS score (>60) can be taken as an indication towards T2DM whereas a low-risk score will favour the diagnosis of other forms of diabetes (other than T2DM). Subjects with IDRS > 60 are at a high risk for development of metabolic syndrome, non-alcoholic fatty liver disease and diabetic complications in the form of coronary artery disease and peripheral vascular disease.

Thus, in current national scenario it is worthwhile to incorporate IDRS for population screening as well as opportunistic screening at clinical practice for getting a lead time in diagnosis of diabetes as well as its complications and metabolic syndrome.

Reply.

Dear Editor

We are grateful to the author for an encouraging reply. IDRS has been performing consistently and should be used as a screening tool in community settings by peripheral health care/auxillary workers. This will not only aid in early identification of patients and hence early diagnosis but also will go a long way in decreasing health burden due to better prognosis. As a screening instrument, it can be used in health care establishments for opportunistic screening. However, patients with high scores should be advised blood sugar level as well as other tests to rule out target organ damages as they remain to be recommended protocol for diagnosis and treatment of Diabetes. Further, IDRS has been used in some studies as prognostic marker in diabetes management. Though research has proved it to be a useful tool, its application in various settings by health care professionals can only reap its true benefits.