Limited Effectiveness of Diabetes Risk Assessment Tools in Seniors' Facility Residents.

Evaluation of the Finnish Diabetes Risk Score (FINDRISC) for diabetes screening in Kayseri, Turkey

To evaluate a modified Finnish Diabetes Risk Score (FINDRISC) for predicting the risk of incident diabetes among white and black middle-aged participants from the Atherosclerosis Risk in Communities (ARIC) study. We assessed 9754 ARIC cohort participants who were free of diabetes at baseline. Logistic regression and receiver operator characteristic (ROC) curves were used to evaluate a modified FINDRISC for predicting incident diabetes after 9 years of follow-up, overall and by race/gender group. The modified FINDRISC used comprised age, body mass index, waist circumference, blood pressure medication and family history. The mean FINDRISC (range, 2 [lowest risk] to 17 [highest risk]) for black women was higher (9.9 ± 3.6) than that for black men (7.6 ± 3.9), white women (8.0 ± 3.6) and white men (7.6 ± 3.5). The incidence of diabetes increased generally across deciles of FINDRISC for all 4 race/gender groups. ROC curve statistics for the FINDRISC showed the highest area under the curve for white women (0.77) and the lowest for black men (0.70). We used a modified FINDRISC to predict the 9-year risk of incident diabetes in a biracial US population. The modified risk score can be useful for early screening of incident diabetes in biracial populations, which may be helpful for early interventions to delay or prevent diabetes.

Background and objectiveDiabetes mellitus (DM) is a chronic, metabolic disease characterized by elevated blood glucose levels that eventually lead to several acute and chronic complications. Type 2 DM (T2DM) is a major healthcare problem globally as well as in the Kingdom of Saudi Arabia (KSA). Predicting and identifying people at high risk for developing T2DM will help implement preventive measures for these individuals. In light of this, the present study was designed to estimate the 10-year risk of developing T2DM among the Saudi general population.MethodologyA descriptive, cross-sectional survey involving 15,509 Saudi individuals was undertaken. The participants were selected from all 13 provinces of KSA based on stratified random sampling. The Finnish Diabetes Risk Score (FINDRISC), a validated tool for T2DM risk assessment, was employed. Descriptive and chi-square analyses were used.ResultsThe mean age of the participants was 28.33 years. Subjects with a moderate, high, and very high risk of developing T2DM within the next 10 years comprised approximately 18% of the sample. The mean FINDRISC was 7.53 [standard deviation (SD): 4.28], which is considered a level associated with a slightly elevated risk of developing T2DM. Of note, 938 participants (6.05%) among the sample population had a high risk of developing T2DM as predicted by FINDRISC. Education, daily physical activity, high blood glucose, and family history of DM were significantly higher in females compared to males (p<0.001). On the other hand, smoking rates and use of antihypertensive medications were substantially higher among males (p<0.001).ConclusionBased on our findings, approximately 18% of the Saudi general population has a moderate to high risk of developing T2DM. T2DM risk assessment should be widely and regularly practiced by general practitioners and internists as part of national programs for diabetes prevention.

Context:India is currently becoming capital for diabetes mellitus. This significantly increasing incidence of diabetes putting an additional burden on health care in India. Unfortunately, half of diabetic individuals are unknown about their diabetic status. Hence, there is an emergent need of effective screening instrument to identify “diabetes risk” individuals.Aims:The aim is to evaluate and compare the diagnostic accuracy and clinical utility of Indian Diabetes Risk Score (IDRS) and Finnish Diabetes Risk Score (FINDRISC).Settings and Design:This is retrospective, record-based study of diabetes detection camp organized by a teaching hospital. Out of 780 people attended this camp voluntarily only 763 fulfilled inclusion criteria of the study.Subjects and Methods:In this camp, pro forma included the World Health Organization STEP guidelines for surveillance of noncommunicable diseases. Included primary sociodemographic characters, physical measurements, and clinical examination. After that followed the random blood glucose estimation of each individual.Statistical Analysis Used:Diagnostic accuracy of IDRS and FINDRISC compared by using receiver operative characteristic curve (ROC). Sensitivity, specificity, likelihood ratio, positive predictive and negative predictive values were compared. Clinical utility index (CUI) of each score also compared. SPSS version 22, Stata 13, R3.2.9 used.Results:Out of 763 individuals, 38 were new diabetics. By IDRS 347 and by FINDRISC 96 people were included in high-risk category for diabetes. Odds ratio for high-risk people in FINDRISC for getting affected by diabetes was 10.70. Similarly, it was 4.79 for IDRS. Area under curves of ROCs of both scores were indifferent (P = 0.98). Sensitivity and specificity of IDRS was 78.95% and 56.14%; whereas for FINDRISC it was 55.26% and 89.66%, respectively. CUI was excellent (0.86) for FINDRISC while IDRS it was “satisfactory” (0.54). Bland-Altman plot and Cohen's Kappa suggested fair agreement between these score in measuring diabetes risk.Conclusions:Diagnostic accuracy and clinical utility of FINDRISC is fairly good than IDRS.

Type 2 diabetes (T2D) represents a major public health challenge in Poland. This study investigated geographic heterogeneity and municipality‑level ecological predictors of a high T2D risk in the Świętokrzyskie Voivodeship (Poland), a region undergoing rapid socioeconomic transition. We aimed to identify associations between the T2D risk, assessed by the Finnish Diabetes Risk Score (FINDRISC), and socioeconomic and environmental factors. This cross‑sectional study analyzed data from 252 427 residents of the Świętokrzyskie Voivodeship aged 45-64 years, without diagnosed diabetes, who participated in a regional prevention program (2019-2022). Individual risk, assessed via the FINDRISC questionnaire, was linked with municipality‑level ecological data. We used a logistic regression model with municipality‑clustered standard errors to identify predictors of a high T2D risk (FINDRISC ≥15). Overall, 13.6% of the participants were at a high risk of diabetes (FINDRISC ≥15), with significant geographic variation (P <0.001). Among municipality‑level predictors, higher unemployment rate was significantly associated with increased odds of a high T2D risk (odds ratio [OR], 1.14 per 1% increase; P <0.001), whereas higher proportions of legally disabled residents and higher annual mean concentrations of particulate matter with aerodynamic diameter of 2.5 μm or smaller were inversely associated with the prevalence of a high T2D risk (OR, 0.98; P = 0.03 and OR, 0.92 per 1 μg/m3; P = 0.001, respectively). Results were robust across sensitivity analyses using alternative FINDRISC cutoffs. Unemployment was a key population‑level determinant of a high T2D risk, whereas other socioeconomic and environmental factors showed null or inverse associations. These findings underscore the importance of considering local context when assessing population‑level health determinants.

Diabetes mellitus (DM) is a major global health issue, with type 2 diabetes (T2D) accounting for over 90% of cases. Community pharmacies, given their accessibility, are well positioned to assist in early detection and management of T2D. This study evaluated post-pandemic T2D risk in a Portuguese population using the Finnish Diabetes Risk Score (FINDRISC) across five community pharmacies. A total of 494 participants aged 40 or older without a prior diagnosis of diabetes were assessed. The mean FINDRISC score was 12.3, and 29.8% were identified as high or very high-risk, with 8.7% referred to general practitioners for follow-up based on elevated glycated hemoglobin (HbA1c). Key risk factors include age, body mass index, waist circumference, lack of physical activity, and family history of diabetes. Lower educational levels were also associated with higher diabetes risk. Community pharmacies are shown to play an essential role in screening and educating at-risk populations, emphasizing the importance of physical activity, healthy diets, and regular monitoring. These findings reinforce the value of community pharmacists in mitigating T2D risk and enhancing public health outcomes through cost-effective, validated screening tools like FINDRISC. Finally, pre-pandemic FINDRISC studies discussed show similar results suggesting that the COVID-19 pandemic did not significantly impact the overall risk profile for T2D.

Aim. To evaluate 10-year risk of potential development of type 2 diabetes (DM) in Russian population with the FINDRISC score, and to assess its associations with social, demographic and behavioral factors by the data from epidemiological study ESSE-RF. Material and methods. In the work, the data used, from multi-center study (Epidemiology of cardiovascular diseases in various regions of Russian Federation: ESSE-RF). Totally, 21923 persons investigated, age 25-64 y.o., of those 1045 (3,76% males, 5,39% females) had DM. To the final analysis 20878 persons included (8058 males, 12820 females) with no DM, for whom the 10-year risk was assessed with the FINDRISC (The FINnish Diabetes RIsk SCore). Level of risk and probability of DM onset were evaluated by the points summation. Also, associations were analyzed with education, marital status, place of inhabitance, income, smoking and alcohol status. Results. The threshold for high DM risk in Russian population was set at ≥12 level, with AUC 0,76, that represents good quality of model. The prevalence of the high risk by Russian criteria was 20,4%. Multifactorial analysis demonstrated that after correction for region and age, DM high risk was associated with smoking cessation (odds ratio (OR) 1,34; 95% confidence interval (CI) 1,14-1,58; р=0,0004) and alcohol consumption (OR 2,01; 95% CI 1,48-2,71; р=0,0001), and in women — with low income, low educational level and being married. Conclusion. Mean score by FINDRISC was 6,5±0,03, and absolute risk 5,3%. There were associations found of higher DM risk (≥12 points) with behavioral factors in males and social-demographic factors in women.

&lt;p dir="ltr"&gt;&lt;b&gt;Background&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;A credible public health survey or surveillance program is judged by its ability to measure intended outcomes accurately and cost effectively. However, in the pursuit of operational efficiency, such programs risk introducing bias in their estimates. This thesis examines several key potential sources of bias in public health surveys, focusing on three main domains: the characteristics and selection of respondents paying attention to the hard-to-reach late respondents, the use of mobile phone technology for data collection, and the adaptation of standardized measurement tools-specifically the Framingham Risk Score (FRS) and the Finnish Diabetes Risk Score (FINDRISC). The tools are internationally recognized for estimating the 10-year risk of cardiovascular disease and type 2 diabetes, respectively. By exploring these domains, this work aims to highlight critical methodological considerations that survey designers and implementers must consider minimizing measurement bias and enhance data validity.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Methods&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;The study was conducted within the Rakai Community Cohort Study (RCCS), a long-standing surveillance program in south-central Uganda. Covering 34 diverse communities, the RCCS focuses on HIV and other health priorities. In each round, 70-80% respond on time, while late respondents require extra effort from the researchers to track them. Study I examined whether late respondents differ from early ones and if their (late respondents) exclusion could bias results. We conducted descriptive analyses and compared these groups using Chi-square tests. Multivariable logistic regression was used to adjust for confounders, reporting adjusted odds ratios (AORs) with 95% confidence intervals. We also modelled interactions with age to estimate marginal predictive means (MPMs), illustrating how the likelihood of late response varies across age groups. The results are reported in constituent manuscript I. The use of mobile phones for population-based surveys is an ongoing global discussion, particularly in resource-limited settings. We leveraged RCCS Rounds 19 and 18 data, collected around the COVID-19 period, and data from a concurrent mobile phone-based surveillance in the same population to compare participation rates by survey modality (face-to-face vs. mobile phone surveys), we assessed phone access, and characterized the differences between respondents reached and missed by each method. The primary independent variable was interviewing modality, with adjustments made for sex, age, community type, HIV status, and other covariates. Robust standard errors accounted for clustering at the individual level. We also examined longitudinal trends in mobile phone ownership, including the frequency of mobile phone number change, the time to change of numbers and multiple SIM ownership. Phone number change was defined as the complete replacement of previously recorded numbers between survey rounds, excluding partial changes. Rates and associated factors were estimated using Poisson regression with generalized estimating equations (GEE), while time to number change was assessed using the Andersen-Gill Cox model to account for repeated measurements. The results are reported in studies II (face-to-face vs mobile phone surveys) and study III (mobile phone ownership, numbers change and time to change analyses) We conducted qualitative exit interviews to assess participants' experiences with the FRS and FINDRISC risk score tools. Interviews were held on the same day, immediately after participants completed the questionnaires and measurement procedures. The analysis, based on 15 interviews, followed an iterative approach. Thematic coding was used to identify and summarize key themes that we report in constituent study IV.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Results&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Overall, 68,263 participants were included in the late respondent analysis. Men were 22% times more likely to be late respondents than women (23% vs. 19%, respectively). This was true for younger participants 15-19 years old relative to 40+years old participants. Compared to the unemployed, participants engaged in formal employment followed by those engaged in fishing were more likely to be late respondents (28% and 27% respectively). When comparing response times between people living with HIV and those who are HIV-negative, no significant difference was observed (AOR=1.06; 95% C.I .: 0.99, 1.13). In women, HIV status had no effect on the marginal predictive mean (MPM) of being late, which declined with age in both groups. Among young men, MPM of being a late respondent was significantly higher in those with HIV but decreased with age. Conversely, in HIV- negative men, the MPM increased with age. In study II, we observed 90% access to mobile phones, with lower access among older people, and people living with HIV. When including only individuals who participated in the previous RCCS survey round, participation in the face-to-face survey (82%) was higher than participation in the mobile phone survey (75%, p &lt; . 001). Survey participation was higher among people living with HIV compared to HIV-negative individuals (84% vs 82%, p&lt; . 001) in the face-to-face survey. In study III we assessed mobile phone ownership. A total of 97,034 participants were included in this analysis. Overall, 61.8% reported owning a phone. Mobile phone ownership increased by 33% over the study period, from 51% in 2010 to 68% in 2020 (p&lt;0.001). Ownership was higher among men. There was no difference in phone ownership by HIV status (adjPR=1.01, 95% CI 0.97-1.05). About 75% of participants who reported more than one sexual partner in the past 12 months owned a mobile phone, compared to 58% who reported zero or one partner in the same period (p&lt;0.001). Phone number change is as high as 15-19/100 person years and consistent across the ten years of observation.&lt;/p&gt;&lt;p dir="ltr"&gt;When we examined participants' experiences with FRS and FINDRISC, we found that overall, the tools were clear and acceptable in this setting. Participants were comfortable with having their weights, waists, heights and other measurements taken if it was by a health worker. There were a few challenges with interpretation and measurement of physical activity, and dietary practice questions given the seasonal variations in their availability in the community.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Conclusion&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;The studies reveal that late respondents are different and cannot be ignored therefore means to speed up their participation should be devised. The use of mobile phones is feasible, there are some differentials in those who are missed by phone surveys (especially men). Meanwhile, mobile phone ownership is on a rapid rise across both sexes with men slightly higher and women rapidly catching up (by 2020). However, the rate of phone number change is quite high and this needs to be considered. The FRS and the FINDRISC scores are generally acceptable, however, some adaptation to match local practices and the seasonal dietary practices need to be addressed during survey planning, data analysis and interpretation.&lt;/p&gt;&lt;p dir="ltr"&gt;Key terms: Late respondents, Mobile phones, Bias, Framingham, Finnish Diabetes Risk Score.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;Paper I: Characterizing late respondents in the Rakai Community Cohort Study, 2012-2020, Uganda&lt;b&gt;. &lt;/b&gt;&lt;b&gt;Robert Ssekubugu&lt;/b&gt;, Zangin Zeebari, Hadija Nakawooya, Ping Teresa Yeh, Anthony Ndyanabo, Fredrick Edward Makumbi, Anna Mia Ekström, Grace Nalwoga Kigozi, Eli. M Binder, Kate Grabowski, David Serwadda, Victor Ssempijja, Larry W Chang, Godfrey Kigozi, Helena Nordenstedt [Manuscript]&lt;/p&gt;&lt;p dir="ltr"&gt;Paper II: Use of Mobile Phone to collect data on COVID-19; phone access and participation rates in Rakai, Uganda. &lt;b&gt;Robert Ssekubugu&lt;/b&gt;, Anthony Ndyanabo, Fredrick Edward Makumbi, Anna Mia Ekström, Laura Bere, Grace Nalwoga Kigozi, Hadijja Nakawooya, Joseph Ssekasanvu, Maria J. Wawer, Fred Nalugoda, Nelson Sewankambo, Victor Ssempijja, Betty Nantume, David Serwadda, Godfrey Kigozi, Ronald H. Gray, Larry W Chang, M. Kate Grabowski, Helena Nordenstedt &amp; Joseph Kagaayi Glob Health Action. 2024 Dec 31;17(1):2419160. &lt;a href="https://doi.org/10.1080/16549716.2024.2419160" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1080/16549716.2024.2419160&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Paper III: Mobile phone ownership, number change, time to change and the implications to public health services delivery in Uganda, 2010-2020&lt;b&gt;. &lt;/b&gt;&lt;b&gt;Robert Ssekubugu&lt;/b&gt;, Ping Teresa Yeh, Hadija Nakawooya, Victor Ssempijja, Godfrey Kigozi, Joseph Kagaayi, Fred Nalugoda, Anna Mia Ekström, Betty Nantume, David Serwadda, Philip Kreniske, Zangin Zeebari, Michelle A. Moffa, Larry W. Chang, Kate M. Grabowski, Fredrick Makumbi and Helena Nordenstedt [Manuscript]&lt;/p&gt;&lt;p dir="ltr"&gt;Paper IV: Cardiovascular (Framingham) and type II diabetes (Finnish Diabetes) risk scores: a qualitative study of local knowledge of diet, physical activity and body measurements in rural Rakai, Uganda&lt;b&gt;. &lt;/b&gt;&lt;b&gt;Robert Ssekubugu&lt;/b&gt;, Fredrick Makumbi1, Rocio Enriquez, Susanne Rautiainen Lagerstrom, Ping Teresa Yeh, Caitlin E. Kennedy, Ronald H. Gray, Lilian Negesa, David M. Serwadda, Godfrey Kigozi, Anna Mia Ekström and Helena Nordenstedt BMC Public Health. 2022 Nov 29;22(1):2214. &lt;a href="https://doi.org/10.1186/s12889-022-14620-9" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1186/s12889-022-14620-9&lt;/a&gt;&lt;/p&gt;

Background: Diabetes mellitus is a real public health problem worldwide and is growing in developing countries. Our aim was to determine the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and to evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire to identify type 2 diabetics in the urban population of Ouagadougou, Burkina Faso. Methodology: This was a cross-sectional study among volunteers aged 18 years and older recruited systematically from November 11 to 16, 2019, in the city of Ouagadougou, Burkina Faso, FINDRISC score was used. Analysis of the Receiver Operating Characteristic (ROC) curve was used to study the diagnostic performance of FINDRISC for the identification of type 2 diabetics. The optimal threshold was determined by the sum of the highest sensitivity and specificity. Multivariate logistic regression was used to analyze the association of each variable used in the calculation of the FINDRISC score. Results: A total of 1276 individuals were included in the analyses, of which 667 (52.27%) were women. The average age was 34.16 years (SD: ±12.42). The prevalence of T2DM was 10.74%. The mean FINDRISC score was 5.85 (SD: ±4.31). The majority (58.54%) of individuals had a low risk of diabetes according to the FINDRISC score 0 - 7, while 3.61% had a score ≥ 15. The FINDRISC score showed good performance (AUC = 0.70) in identifying undiagnosed type 2 diabetics. However, the variables in the score that best predicted the likelihood of being diabetic were age (p < 0.001), daily physical activity (p = 0.004), use of antihypertensive medication (p = 0.007) and waist circumference (p < 0.001). The optimal cut-off score ≥ 7 was the best predictor of the likelihood of having T2DM. Conclusion: The Finnish Risk Score (FINDRISC) is a good predictor of the risk of dysglycemia in Burkina Faso. It is a score to be promoted in daily clinical practice because it is easy to use, affordable and non-invasive. Further studies are needed to make modifications to the FINDRISC questionnaire in case it is applied to other ethnic groups.

Introduction Shift work is associated with type 2 diabetes mellitus (T2DM) partially explained through decreased insulin sensitivity by disruption of the day/night rhythm. Lifestyle interventions can prevent the onset of T2DM, and avoid complications. This study aimed to (1) report the prevalence of pre-diabetes and T2DM in shift workers, (2) study the impact of lifestyle advice on the risk for T2DM. Methods A two-step method was used: (1) the risk for T2DM was assessed by the FINnish Diabetes RIsk SCore (FINDRISC), (2) HbA1c was determined by finger prick when FINDRISC was ≥12. Results were discussed during medical consultation, and lifestyle advice was given. After three months, the evolution of the FINDRISC score and the HbA1c was evaluated. This study was approved by the ethics committee of Ghent University. Results The response rate was 47%; 44.6% of them were shift workers. 120 participants scored ≥12 on the FINDRISC. According to the HbA1c values, 26.7% had pre-diabetes and 3.3% had T2DM. There was a positive/weak correlation between FINDRISC score and HbA1c (r=0,29; p=0.003). No statistical links were found between shiftwork and FINDRISC (x²; p=0.502). After the intervention 14 of 23 persons had a lower FINDRISC (median from 14 to 12, p=0.010), no significant difference was found for Hba1c. Discussion No clear link was found between shift work and diabetes risk. Lifestyle advice did not affect HbA1c significantly after three months. Further research is needed to investigate the risk and preventive intervention among larger groups of shift workers. Conclusion (Pre-)diabetes can easily be detected via the two-step method.

Objective : to investigate the prevalence of traditional risk factors (RFs) and to determine a 10-year risk for type 2 (T2) diabetes mellitus (DM), by using the Finnish Diabetes Risk Score (FINDRISC) in patients with rheumatoid arthritis (RA). Subjects and methods. The investigation enrolled 418 RA patients without a history of DM. The median age of the participants was 54 [41; 63] years; the median disease duration was 6 [2; 12] years. Most of the patients were positive for rheumatoid factor (75.6%) and anti-cyclic citrullinated peptide antibodies (77.3%) and had moderate and high RA activity (81.8%). Glucocorticoids (GCs), disease-modifying anti-rheumatic drugs, and biological agents were used in 42.1, 66.7, and 23.9% of the patients, respectively. FINDRISC was used to assess the risk of T2DM. A control group consisted of 100 gender- and age-matched individuals without inflammatory joint diseases or DM. Results and discussion. The most common modifiable traditional RFs in RA were abdominal obesity (AO) (63.6%), overweight (50.7%), and lack of physical activity (70.3%); the non-modifiable RF was age older than 45 years (69.1%). The RA and control groups showed the similar prevalence of RFs, except for AO that was more common in the absence of inflammatory joint diseases (75.0%) (p = 0.03). The number of RFs did not differ in RA patients (median RFs, 4 [2; 5]) and control individuals (4 [3; 5]) (p = 0.23). The moderate risk of developing T2DM in the ensuing ten years was 20.1 and 18.0% in RA patients and control individuals, respectively; the high risk was in 19.6 and 24.0% and the very high risk was in 2.7 and 2.0%, respectively (p > 0.05 in all cases). In RA, there was a weak correlation between the number of RFs and DAS28 (r = 0.10; p = 0.05), RFs and HAQ (r = 0.19; p < 0.01). Examinations detected fasting hyperglycemia (glucose ≥6.1 mmol/l) in 3.8% of the RA patients with a low/slightly increased risk for T2DM and in 16.1% of those with its moderate, high, and very high risks (p < 0.01). The use of GCs did not affect the number of RFs, the distribution of groups at risk for DM, and the frequency of hyperglycemia. These findings can lead to the conclusion that the risk of developing T2DM in RA is associated with a high frequency of modifiable traditional RFs, such as obesity and lack of physical activity. FINDRISC is a simple method to identify RA patients who need lifestyle monitoring and modification, as well as an additional examination to rule out latent T2DM.

Glycemic Control and Risk of Cardiovascular Disease Hospitalization and All-Cause Mortality

BackgroundStudies specifically examining the association between glycated hemoglobin A1c (HbA1c) levels and ischemic stroke/systemic thromboembolism (IS/SE) risk in atrial fibrillation (AF) patients are limited. Here, we investigated the association between HbA1c levels and the risk of IS/SE, as well as major bleeding, among AF patients with or without oral anticoagulants (OACs). We also compared the effectiveness and safety of warfarin and direct oral anticoagulants (DOACs) in different HbA1c categories.MethodsWe utilized medical data from a multi-center healthcare provider in Taiwan, which included 34,036 AF patients with serum HbA1c data available within 3 months after AF being diagnosed. Patients were divided into seven study groups according to their HbA1c levels: < 5.4%, 5.4%–5.6%, 5.7%–5.9%, 6.0%–6.4%, 6.5%–6.9%, 7.0%–7.9%, and ≥ 8.0%. The risks of IS/SE and major bleeding were compared among the groups after adjusting for baseline stroke and bleeding risk factors.ResultsCompared with the patients with HbA1c level < 5.4%, IS/SE risk significantly increased at HbA1c levels higher than 6.5% [adjusted hazard ratio (HR): 1.20, 95% confidence interval (CI): 1.00–1.43 for HbA1c level 6.5%–6.9%; 1.32, (95% CI 1.11–1.57) for HbA1c level 7.0%–7.9%; and 1.48 (95% CI 1.25–1.76) for HbA1c level ≥ 8.0%]. These results were generally consistent in AF patients without OACs (n = 24,931). However, among 9105 patients receiving OACs, IS/SE risk was not higher for patients having higher HbA1c levels. The risk of major bleeding was comparable across all HbA1c categories. Compared with warfarin, DOACs were associated with lower risks of IS/SE (adjusted HR: 0.61, 95% CI 0.49–0.75) and major bleeding (adjusted HR: 0.30, 95% CI 0.21–0.42) without interactions across different HbA1c categories (all P interactions > 0.05).ConclusionFor AF patients, IS/SE risk significantly increased once HbA1c levels exceeded 6.5%, and OACs may attenuate these associations. Compared with warfarin, DOACs were more effective and safer across broad HbA1c categories. Therefore, in addition to prescribing DOACs when indicated, more aggressive glycemic control to achieve an HbA1c level < 6.5% may be considered for eligible AF patients and should be tested in further prospective studies.

Until now, no systematic screening for T2D or prevention activities targeting T2D has been implemented in Colombia. The aims of this study were i) describe the feasibility of implementing the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose metabolism disorders (GMD) in the primary health care system in Barranquilla in Colombia during 2011 and 2012, and ii) to describe the risk factors for T2D in the population screened. This screening was opportunistic among people aged 34-60 years living in five primary health care catchment areas in Barranquilla, Colombia. People with 13 or more FINDRISC points were invited to an oral glucose tolerance test (OGTT). Out of 14193 participants with the FINDRISC completed, 35% (n=4915) had a score of 13 points or higher (men 23%, women 40%). Among those with FINDRISC completed, the percentage of people with BMI<25 kg/m2 was 46% in men and 35% in women. The prevalence of screen-detected T2D was 18% in men and 12% in women, respectively, among those with FINDRISC >12 attending an OGTT. In both sexes the prevalence of isolated IGT, isolated IFG, and IFG and IGT combined were 8%, 11%, and 8%, respectively. In total, 2% of all 14 193 screened participants had undetected T2D and 7% GMD. This figure would potentially be 4.6% (T2D), respectively 15% (GMD) if all with a FINDRISC>12 attend the OGTT. Thus, we found the FINDRISC to be a useful tool to identify people with GMD. This article is protected by copyright. All rights reserved.

The risk of developing type 2 diabetes (T2D) is significantly related to low socioeconomic status (SES) in developed countries, but there is a dearth of evidence for such a relationship in developing countries. We aimed to verify the relationship between the risk-frequency of developing T2D and SES in a local population of Argentina. This was a cross-sectional study. We interviewed 150 people 45–64 years of age living in a district of Ensenada municipality (Buenos Aires, Argentina). For the interview we used three questionnaires: (i) one to record identification data anonymously, (ii) the Finnish Diabetes Risk Score (FINDRISC), and (iii) a questionnaire collecting information about educational level and the total household income. Statistical analysis was performed with parametric or non-parametric tests as appropriate. The interviewed were mostly women (56%) with an average low education and income level; 40% presented a moderate to very high risk for developing T2D, whereas 60% presented a low (24.7%) or slightly high (35.3%) risk. The risk score increased significantly with lower SES. Moreover, respondents that reached a higher education level than their parents showed a non-significantly lower average FINDRISC score than those who did not reach this improvement. Our data show, in a developing country, an inverse relationship between the risk of developing T2D and SES.