Diabetes risk score in Oman: A tool to identify prevalent type 2 diabetes among Arabs of the Middle East

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Abstract

We used Oman's 1991 National Diabetes Survey data (n = 4881) to develop a simple diabetes risk score for identification of individuals at high risk of having diabetes mellitus. The logistic regression model used included age, waist circumference, body mass index, family history of diabetes and hypertension status at the time of the survey for individuals aged ≥20 years. The validity of the model was assessed in another cohort (2001 Nizwa study n = 1432). On applying this model to both cohorts, the area under the receiver-operating characteristic curve was 0.83 (95% confidence interval (CI) 0.82–0.84) for the 1991 cohort and 0.76 (95%CI 0.74–0.79) for the 2001 cohort. The Risk Score of >10 was depicted as the optimal cut-point to predict diabetes diagnosed by serum glucose ≥11.1 mmol/L 2-h post 75 g oral glucose load. This score had a sensitivity of 78.6 and 62.8% and specificity of 73.4 and 78.2% in the two cohorts, respectively. Test of the Thai, Dutch, Finnish and Danish diabetes risk scores showed poor performance of these models among Omani Arabs. In comparison, the self-administered diabetes risk score of Oman could identify most individuals at high risk of having type 2 diabetes in community-based settings in Oman.

Introduction

Both developed and developing countries are witnessing an increasing incidence and prevalence of diabetes mellitus. Further, diabetes and its complications are becoming a dominant source of morbidity and mortality worldwide [1]. Many epidemiological studies have shown that type 2 diabetes and other categories of glucose intolerance are highly prevalent among Arab populations of the Middle East [2], [3], [4]. Recent intervention studies have clearly shown that diabetes could be reduced among high-risk individuals [5], [6], [7]. Nonetheless, most current screening modalities to identify high risk individuals are invasive (fasting or random plasma glucose) and time consuming (oral glucose tolerance test), and not really suitable for the population-based screening [8]. Thus, identifying people at high risk of developing type 2 diabetes through a simple method that could be used by individuals themselves to assess their risk profile may contribute to preventive efforts of public health magnitude. Such an approach has been evaluated in a number of populations with encouraging results [9], [10], [11], [12], [13], but it has been also realized that it may not be universally applicable among all ethnic groups and populations [14], [15].

In this study, we aimed to develop a convenient, acceptable and inexpensive risk score to characterise individuals of Arab origin according to their possible risk of having type 2 diabetes mellitus. Further, we compared the performance of the model developed with other predictive models from Thailand [13], the Netherlands [9], Finland [16] and Denmark [17].

Section snippets

Materials and methods

We used two cross sectional datasets; the 1991 National Diabetes Survey of Oman (model development data) and the 2001 Nizwa Survey (model validation data). Nizwa is a city of ∼70,000 population, 160 km south to the capital city Muscat. The 1991 survey contained 4881 subjects and the 2001 survey 1432 subjects after excluding pregnant women, subjects below 20 years of age or with missing relevant data. The response rate in the former study was 80% and in the latter 75%. Details of sampling schemes

Model development

In the 1991 survey, there were 4881 individuals of whom 485 (9.9%) had diabetes mellitus (Table 1). The multivariate logistic regression model based on the 1991 survey is shown in Table 2. The probability of diabetes increased with increasing age, waist circumference, BMI, presence of hypertension at the time of the survey and with positive family history of diabetes. Age and family history of diabetes were the strongest predictors of prevalent diabetes, while waist circumference, BMI and the

Discussion

Current screening methods for type 2 diabetes mellitus include various risk assessment questionnaires, biochemical tests and combinations of the two [8]. However, most such tests need some training to perform and biochemical tests are invasive and time consuming. Thus, the need of a simple risk assessment test based on causal risk factors for type 2 diabetes, which is self-administered, becomes of paramount importance especially in community-based settings in developing countries.

The use of

Acknowledgment

We would like to thank Mr. Khalid Saleem for his technical support during this study.

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