Non-invasive type 2 diabetes risk scores do not identify diabetes when the cause is β-cell failure: The Africans in America study

Abstract

BackgroundEmerging data suggests that in sub-Saharan Africa β-cell-failure in the absence of obesity is a frequent cause of type 2 diabetes (diabetes). Traditional diabetes risk scores assume that obesity-linked insulin resistance is the primary cause of diabetes. Hence, it is unknown whether diabetes risk scores detect undiagnosed diabetes when the cause is β-cell-failure.AimsIn 528 African-born Blacks living in the United States [age 38 ± 10 (Mean ± SE); 64% male; BMI 28 ± 5 kg/m2] we determined the: (1) prevalence of previously undiagnosed diabetes, (2) prevalence of diabetes due to β-cell-failure vs. insulin resistance; and (3) the ability of six diabetes risk scores [Cambridge, Finnish Diabetes Risk Score (FINDRISC), Kuwaiti, Omani, Rotterdam, and SUNSET] to detect previously undiagnosed diabetes due to either β-cell-failure or insulin resistance.MethodsDiabetes was diagnosed by glucose criteria of the OGTT and/or HbA1c ≥ 6.5%. Insulin resistance was defined by the lowest quartile of the Matsuda index (≤ 2.04). Diabetes due to β-cell-failure required diagnosis of diabetes in the absence of insulin resistance. Demographics, body mass index (BMI), waist circumference, visceral adipose tissue (VAT), family medical history, smoking status, blood pressure, antihypertensive medication, and blood lipid profiles were obtained. Area under the Receiver Operator Characteristics Curve (AROC) estimated sensitivity and specificity of each continuous score. AROC criteria were: Outstanding: >0.90; Excellent: 0.80–0.89; Acceptable: 0.70–0.79; Poor: 0.50–0.69; and No Discrimination: 0.50.ResultsPrevalence of diabetes was 9% (46/528). Of the diabetes cases, β-cell-failure occurred in 43% (20/46) and insulin resistance in 57% (26/46). The β-cell-failure group had lower BMI (27 ± 4 vs. 31 ± 5 kg/m2P < 0.001), lower waist circumference (91 ± 10 vs. 101 ± 10cm P < 0.001) and lower VAT (119 ± 65 vs. 183 ± 63 cm3, P < 0.001). Scores had indiscriminate or poor detection of diabetes due to β-cell-failure (FINDRISC AROC = 0.49 to Cambridge AROC = 0.62). Scores showed poor to excellent detection of diabetes due to insulin resistance, (Cambridge AROC = 0.69, to Kuwaiti AROC = 0.81).ConclusionsAt a prevalence of 43%, β-cell-failure accounted for nearly half of the cases of diabetes. All six diabetes risk scores failed to detect previously undiagnosed diabetes due to β-cell-failure while effectively identifying diabetes when the etiology was insulin resistance. Diabetes risk scores which correctly classify diabetes due to β-cell-failure are urgently needed.

Predicting the Risk of Type 2 Diabetes Mellitus with the New Chinese Diabetes Risk Score in a Cohort Study

“…Generally, these models are composed of a few variables that can easily be obtained through medical health checks, and can predict the T2DM risk by adding up the scores of each variable (9). The Finnish Diabetes Risk score (FINDRISC) (10,11), Cambridge Risk Score (CRS) (12), QDiabetes (13), and the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) are popular models used for T2DM risk prediction (14). However, previous studies were either limited by an inadequate sample size (10,14), ethnicity derived from the Caucasian population (10)(11)(12)(13), or validation only in a cross-sectional study (10,11,14).…”

“…The Finnish Diabetes Risk score (FINDRISC) (10,11), Cambridge Risk Score (CRS) (12), QDiabetes (13), and the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) are popular models used for T2DM risk prediction (14). However, previous studies were either limited by an inadequate sample size (10,14), ethnicity derived from the Caucasian population (10)(11)(12)(13), or validation only in a cross-sectional study (10,11,14). Further, previous Chinese risk score models for screening T2DM either failed to report important indicators (e.g., sex, family history of diabetes), consisted of clinical measurements, or even had low predictive values (15)(16)(17).…”

LncRNA LINC01018 Screens Type 2 Diabetes Mellitus and Regulates β Cell Function Through Modulating miR-499a-5p

“…With the formation of unhealthy working and living styles, such as long-term high-glucose and fat diet, lack of exercise, and sitting for a long time, the prevalence of T2DM is increasing year by year, which has become one of the major health problems and attracted global attention [1,2]. Insulin resistance and β cell failure have been considered the main causes of T2DM, and the function of pancreatic islet β cells greatly mediate β cell failure [3][4][5][6][7]. Mature pancreatic islet β cells could secrete insulin and therefore low blood sugar and maintain glucose homeostasis [8,9].…”