Saudi Risk Scores for Type 2 Diabetes and Dysglycemia Open Access

Abstract

Objective: To cost-effectively screen for type 2 diabetes in Saudi Arabia, we developed and internally validated risk scoring tools to help identify those with undiagnosed diabetes and dysglycemia.

Research Design and Methods: Data from 1,485 non-pregnant Saudi nationals who were ≥ 20 years old and did not have a current diagnosis of diabetes were obtained from urban and rural primary health care centers in 2009. Anthropometric measurements, socio-demographic and lifestyle information, and past medical and family history were obtained through physician-administered interviews. Oral glucose tolerance test data were used to define diabetes (FPG ≥ 126 mg/dL or 2hrPP ≥ 200 mg/dL) and dysglycemia (FPG ≥ 100 mg/dL or 2hrPP ≥ 140mg/dL). Predictive models were developed using data from 1,435 individuals. Multi-variable logistic regression and Receiver-Operating Characteristic curves were used to develop and evaluate two risk scores for each diabetes and dysglycemia. Validation was performed using a hold-out sample of 50 individuals.

Results: Both risk scores for undiagnosed diabetes contained age, gestational diabetes, smoking, family history of diabetes, central obesity, and either hypertension or sex with sensitivities ≥ 68% and specificities ≥ 57%. Dysglycemia risk scores contained age, gestational diabetes, hypertension, and either body mass index or waist circumference plus gender with sensitivities ≥ 65% and specificities ≥ 57%. All performed equally well, if not better, in the hold-out sample.

Conclusions: Simple non-invasive risk scores from a Saudi adult population can potentially aid in screening for undiagnosed diabetes or dysglycemia and should be further validated in prospective studies.

Table of Contents

CHAPTER 1: INTRODUCTION....................................................................................................................1
Introduction.........................................................................................................................................2
Prevalence of T2DM in Saudi Arabia..........................................................................................................3
Morbidity and Mortality Related to T2DM and the Effects of Early and Comprehensive Risk Factor Control...............3
Screening............................................................................................................................................6
Risk Scores..........................................................................................................................................8

Problem Statement...............................................................................................................................10

Purpose Statement...............................................................................................................................11

Significance Statement..........................................................................................................................12

Definition of Terms................................................................................................................................12

References..........................................................................................................................................14

CHAPTER 2: COMPREHENSIVE REVIEW OF THE LITERATURE...........................................................................21

Risk Scores..........................................................................................................................................24

Gulf Countries.......................................................................................................................................27

Others.................................................................................................................................................32

Conclusion...........................................................................................................................................36

References...........................................................................................................................................42

CHAPTER 3: MANUSCRIPT........................................................................................................................47

Contribution of Student...........................................................................................................................49

Abstract...............................................................................................................................................50

Introduction..........................................................................................................................................51

Methods...............................................................................................................................................53

Study Design.........................................................................................................................................53

Data Collection.......................................................................................................................................53

Study Variables......................................................................................................................................54

Data Cleaning........................................................................................................................................55

Data Analysis.........................................................................................................................................55

Results.................................................................................................................................................57

Diabetes...............................................................................................................................................58

Dysglycemia..........................................................................................................................................58

Discussion.............................................................................................................................................59

Conclusion.............................................................................................................................................62

References............................................................................................................................................63

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS......................................................................................74

References............................................................................................................................................78

TABLES AND FIGURES
TABLE 1: Summary of the Literature on Diabetes and Dysglycemia Risk Scores in the Middle East..........................38
TABLE 2: Population Demographics and Prevalence of Prediabetes and Diabetes within each Variable Level

for Non-Pregnant Saudi Adults Aged ≥ 20 Years (2009)...............................................................................70
TABLE 3: Type 2 Diabetes Mellitus and Dysglycemia Final Models and Risk Score Development for Non-Pregnant

Saudi Adults Aged ≥ 20 Years, N = 1435 (2009)...........................................................................................71
FIGURE 1: Receiver-Operating Characteristic (ROC) Curves for Type 2 Diabetes Mellitus (T2DM) and Dysglycemia

Final Models for Non-Pregnant Saudi Adults Aged ≥ 20 Years in 2009 (N=1435)..................................................72
TABLE 4: Performance Indicators for Type 2 Diabetes Mellitus and Dysglycemia Risk Scores for Saudi Non-Pregnant

Adults ≥ 20 Years Old (2009)....................................................................................................................73

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Risk Score Saudi Arabia Dysglycemia Diabetes
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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