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Diagnostic validity of the pre-diabetes scale among at-risk rural Iranian adults for screening for pre-diabetes

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Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Background

An intense increase in pre-diabetes has taken place among the worldwide population each year. The purpose of this study was to assess the diagnostic validity of the American Diabetes Association (ADA) screening questionnaire for identifying pre-diabetes in the Iranian rural population.

Methods

This study was conducted in Ahar County, East Azarbaijan, Iran. The participants (n = 440) were randomly recruited via trained community health care workers. The ADA questionnaire including six items (age, gender, having family members with diabetes, obesity, hypertension, and physical activity) is the screening tool used to identify people at high risk for developing type 2 diabetes. The World Health Organization (WHO) forward/backward translation protocol was used for translating the assessment tool. The diagnosis of pre-diabetes was defined based on the fasting blood glucose (FBG, as a gold standard) cut-points of 100 mg/dl to 125 mg/dl. We assessed the criterion validity and diagnosis characteristics of the ADA questionnaire in the diagnosis of pre-diabetes using the measures of sensitivity, specificity, and receiver operating characteristics (ROC) curves. In addition, the optimal cut-point of the ADA questionnaire for the diagnosis of pre-diabetes was computed using Youden’s index.

Results

A total of 440 adults ages 30–65 years (Mage = 48.8 years, SDage = 11.2 years) were included in the study. Around half of the participants were women (50%), illiterate (51.4%), and married (85.2). In the pre-diabetes diagnosis scale, the present cut-point yielded a sensitivity of 98.7 (95% CI:96.6–99.6), specificity of 53.1 (95% CI: 44.6–61.5), positive predictive value (PPV) of 81.4 (95% CI:77–85.3), positive predictive value (NPV) of 95.0 (95% CI:87.7–98.6), and accuracy of 83.9 (95% CI:81.4–89.2) with an area under curve (AUC) of 0.84 (95% CI: 0.80 − 0.89).

Conclusions

The Persian version of the ADA questionnaire had good sensitivity and fair specificity for pre-diabetes diagnosis among rural adults at high risk for developing type 2 diabetes. The study provided evidence for the ADA questionnaire as a valid and reliable tool for identifying pre-diabetes in a rural area. Identifying rural residents in the early stage of developing diabetes with a simple and accurate instrument without the need for a FBG test contributes to controlling the disease in areas with limited access to health services.

Trial registration

The study is not a trial; the registration number is not applicable.

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Data availability

The data collection tools and datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

CVD:

cardiovascular diseases

ADA:

American diabetes association

WHO:

World Health Organization

FBG:

Fasting blood glucose

NHANES:

National Health and Nutrition Examination Survey

BMI:

Body Mass Index

NPV:

Negative Predictive Value

PPV:

Positive Predictive Value

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Acknowledgements

We are grateful to Tabriz University of Medical Sciences for providing facilities for the study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Correspondence to Leila Jahangiry.

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Informed consent was obtained from all participants. The study received ethical approval from the Ethics Committee of Tabriz University of Medical Sciences (NO: IR. TBZMED. REC. 1395. 13).

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Jahangiry, L., Shamizadeh, T., Sarbakhsh, P. et al. Diagnostic validity of the pre-diabetes scale among at-risk rural Iranian adults for screening for pre-diabetes. J Diabetes Metab Disord 19, 823–828 (2020). https://doi.org/10.1007/s40200-020-00568-3

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