The positive predictive value was higher in men than women and in older than younger individuals. Our results indicate that the impact of sex and age on diabetes risk is not fully captured by FINDRISC, and that refinements to it might improve diabetes prediction. Type 2 diabetes is partly preventable by lifestyle intervention, 3—5 but effective intervention is not easy to implement on a population level.
Cost-effective, non-invasive and reliable risk screening tools for diabetes are important for early diagnosis, and likewise to recognize people at high risk of developing type 2 diabetes who can be targeted in sustainable prevention strategies. One recommended and widely used risk screening tool is the Finnish Diabetes Risk Score FINDRISC , an eight-item questionnaire including age; body mass index BMI ; waist circumference; physical activity; daily consumption of fruits, berries, or vegetables; history of antihypertensive drug treatment; history of high blood glucose; and family history of diabetes.
Furthermore, it is not clear whether an elevated FINDRISC score carries a similar risk of diabetes in younger compared with older adults, and in men compared with women.
However, two studies reported that among people with elevated FINDRISC, undiagnosed diabetes and high-risk conditions of diabetes such as metabolic syndrome, fasting plasma glucose, 2 hours plasma glucose, lipids, and blood pressure were more common in men than in women. The HUNT includes comprehensive questionnaires, interviews, clinical measurements, and a collection of biological samples.
Details about the study are described elsewhere. Weight and height were measured with the participants wearing light clothes without shoes, and BMI was calculated as weight in kg divided by the squared value of height in meters.
Waist circumference was measured horizontally at the level of the umbilicus with a non-stretchable band, the participant standing, and the arms hanging relaxed. The HUNT3 survey also included information on other clinical characteristics associated with diabetes. The self-administered questionnaire included information on smoking habits and history of cardiovascular diseases. Blood pressure and resting heart rate were measured three times while the participants were sitting, at 1 min intervals using an automated blood pressure monitor based on oscillometry Dinamap XT; Critikon, Tampa, Florida, USA.
The mean values of the second and third measurements were used in the analyses. Concentrations of total cholesterol, high-density lipoprotein HDL cholesterol, triglycerides, and creatinine were measured in non-fasting serum samples. In the present study, we used information from the baseline examination, which included a questionnaire and clinical and laboratory measurements.
The OGTT was performed by giving the participants 75 g of glucose dissolved in mL of water, to be consumed within 5 min. Glucose levels were measured in serum samples drawn before fasting and min after the glucose ingestion. Whole blood glycated hemoglobin HbA1c was measured in all the participants.
IGT was defined as min serum glucose of 7. IFG was defined as fasting serum glucose of 6. Statistical analysis Among 50 participants in the HUNT3 survey, we excluded persons with previously known diabetes and with missing information on self-reported diabetes, leaving 48 participants eligible for this study. A total of 47 Ethics All participants signed an informed consent.
The score components that led to the higher prevalence among women were waist circumference, family history of diabetes, and previously measured high blood glucose see online supplementary table S1. All score components contributed to the higher prevalence at older ages, except intake of fruit, berries, and vegetables see online supplementary table S1. For both outcomes, the prevalence was higher among women than men and increased considerably with age table 2.