Three Questions Show Type 2 Diabetes Risk

(2) Those who were obese -- with a body mass index (BMI) greater than 30

Harold Bays, MD, of the Louisville Metabolic and Atherosclerosis Research Center in Kentucky, reported at the Obesity Society meeting that those who were positive for the 3 criteria had a 19.9% risk of developing type 2 diabetes over five years of follow-up. Younger individuals with a BMI less than 25 and no family history of the disease, however, had an almost negligible five-year risk (0.3%), The three-item screener might have advantages over more established tools that use seven or more variables because it might be a less cumbersome way for patients to identify undiagnosed diabetes and start treatment, he said. The simplified tool emphasizes that weight loss is an option that patients can use to reduce their risk of type 2 diabetes, Bays said.

"I think that's a crucial message to be sent to patients," he said. "It's something that they can proactively address in order to reduce their risk of a serious disease." There are several algorithms available to estimate the risk of developing type 2 diabetes, including the American Diabetes Association's (ADA's) Diabetes Risk Test, which includes seven variables -- age, race, family history of diabetes, obesity, physical activity, hypertension, and gestational diabetes.

To look at whether it would be feasible to simplify that score with just three variables -- age, family history, and obesity -- Bays and his colleagues turned to the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD), a five-year population-based survey.

A baseline survey was sent in 2004 to 22,001 adults in the U.S, with annual follow-up questionnaires sent through 2009. From the respondents who were free from diabetes at baseline and provided information at the five-year follow-up, the researchers identified high-risk and low-risk groups according to age, family history, and obesity.

Overall, there were 290 high-risk individuals who were 55 or older, were obese, and had a family history of diabetes, and 408 low-risk individuals who were younger than 55, with a BMI less than 25 and no family history of diabetes.

Through five years of follow-up, 19.9% of the high-risk individuals reported developing type 2 diabetes, compared with only 0.3% of the low-risk individuals (P<0.0001).

Bays noted that if a clinician is not currently doing any assessment for type 2 diabetes risk, then whether the simplified tool is inferior or superior to the full algorithm is irrelevant. Those using the full model should probably keep using it, he said, but those who are not using anything might be motivated to start using the simpler option.

Practice Pearls:

• Explain that a study found that being age 55 or older, having a body mass index (BMI) greater than 30, and having a family history of diabetes predicted a higher risk of developing type 2 diabetes over five years, compared with those who were under 55 with a BMI less than 25 and no family history of diabetes.

• Note that although the three-item tool was simpler than the seven-item instrument advocated by the American Diabetes Association, the two instruments were not directly compared in this study.

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  

Bays H, et al "Adiposity, age, and family history as a simplified prediction of future diabetes mellitus from the SHIELD study" OBESITY 2011; Abstract 810-P.