All DRSs correlated significantly with components of MetSyn, HOMA2–insulin resistance, high-sensitive C-reactive protein, and uric acid levels, all of which were markers of insulin resistance (supplementary Table S1, found in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc09-0694/DC1
). However, HOMA2-β, a measure of insulin secretion, did not strongly correlate with DRSs (supplementary Table S1). All DRSs were associated with reduced MDRD GFR and with increased urine albumin excretion (supplementary Table S1). The prevalence of screening-detected diabetes (SDM), MetSyn, and CKD increased significantly with increasing DRSs (all P
for trend <0.0001, supplementary Figs. S1–S3).
The predictive performance of 10 DRSs for SDM, MetSyn, and CKD are summarized in . The best area under the ROC for SDM was 0.74 (95% CI 0.70–0.77, ), with 68% sensitivity and 70% specificity using optimal cutoff values. There were no statistical differences in the area under the ROC for SDM among ARIC, QDScore, Cambridge, FINDRISC, Oman, Danish, and Thai scores. However, the Cambridge risk score and the FINDRISC outperformed the other DRSs in model fit. Using stepwise logistic regression, we identified age, waist circumference, medication for hypertension, and family history of diabetes as independent predictors for SDM. The area under ROC of the logistic regression model based on these predictors was 0.75 (95% CI 0.71–0.78) for SDM, similar to those of DRSs.
The predictive performance of 10 diabetes risk scores for screening-detected diabetes, metabolic syndrome, and CKD
The best area under the ROC for MetSyn was 0.82 (95% CI 0.81–0.84, ) with 70% sensitivity and 83% specificity. There were no statistical differences in the areas under the ROC among the DESIR, Thai, and ARIC scores for MetSyn. However, the ARIC score outperformed other DRSs in model fit.
The best area under the ROC curves for CKD was 0.71 (95% CI 0.68–0.73) (supplementary Fig. S2). The sensitivity was 64% and specificity 68% to detect CKD. The ARIC score outperformed other DRSs in discriminative performance for CKD and model fit.