Saudi Risk Scores for Type 2 Diabetes and Dysglycemia 公开

Chang, Jennifer Li-Chai (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/w37637068?locale=zh
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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

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