Open AccessNon‐laboratory‐based risk assessment model for case detection of diabetes mellitus and pre‐diabetes in primary care
Author(s) -
Dong Weinan,
Tse Tsui Yee Emily,
Mak Lynn Ivy,
Wong Carlos King Ho,
Wan Yuk Fai Eric,
Tang Ho Man Eric,
Chin Weng Yee,
Bedford Laura Elizabeth,
Yu Yee Tak Esther,
Ko Wai Kit Welchie,
Chao Vai Kiong David,
Tan Choon Beng Kathryn,
Lam Lo Kuen Cindy
Publication year - 2022
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13790
Subject(s) - medicine , diabetes mellitus , receiver operating characteristic , logistic regression , waist , area under the curve , population , body mass index , endocrinology , environmental health
More than half of diabetes mellitus (DM) and pre‐diabetes (pre‐DM) cases remain undiagnosed, while existing risk assessment models are limited by focusing on diabetes mellitus only (omitting pre‐DM) and often lack lifestyle factors such as sleep. This study aimed to develop a non‐laboratory risk assessment model to detect undiagnosed diabetes mellitus and pre‐diabetes mellitus in Chinese adults. Methods Based on a population‐representative dataset, 1,857 participants aged 18–84 years without self‐reported diabetes mellitus, pre‐diabetes mellitus, and other major chronic diseases were included. The outcome was defined as a newly detected diabetes mellitus or pre‐diabetes by a blood test. The risk models were developed using logistic regression (LR) and interpretable machine learning (ML) methods. Models were validated using area under the receiver‐operating characteristic curve (AUC‐ROC), precision‐recall curve (AUC‐PR), and calibration plots. Two existing diabetes mellitus risk models were included for comparison. Results The prevalence of newly diagnosed diabetes mellitus and pre‐diabetes mellitus was 15.08%. In addition to known risk factors (age, BMI, WHR, SBP, waist circumference, and smoking status), we found that sleep duration, and vigorous recreational activity time were also significant risk factors of diabetes mellitus and pre‐diabetes mellitus. Both LR (AUC‐ROC = 0.812, AUC‐PR = 0.448) and ML models (AUC‐ROC = 0.822, AUC‐PR = 0.496) performed well in the validation sample with the ML model showing better discrimination and calibration. The performance of the models was better than the two existing models. Conclusions Sleep duration and vigorous recreational activity time are modifiable risk factors of diabetes mellitus and pre‐diabetes in Chinese adults. Non‐laboratory‐based risk assessment models that incorporate these lifestyle factors can enhance case detection of diabetes mellitus and pre‐diabetes.