Validating the Diabetes Risk Score (DRS) app to detect persons at risk of diabetes in Hong Kong Chinese population

Dr Leung, Yee Man Angela   (Principal Investigator (PI))

Dr Chau Pui Hing   (Co-Investigator)

Professor Lam Cindy Lo Kuen   (Co-Investigator)

Emeritus Professor Lam Karen Siu Ling   (Co-Investigator)

Dr Yu Yee Tak Esther   (Co-Investigator)

Dr Wong Carlos King Ho   (Co-Investigator)

11

2015-04-15

2016-03-30

56625

Validating the Diabetes Risk Score (DRS) app to detect persons at risk of diabetes in Hong Kong Chinese population

at risk group, Chinese, diabetes, mobile app, prevention, validation

Diabetes/Metabolism

201411159145

Seed Fund for PI Research – Basic Research

2014

Completed

Prevention of diabetes is at the top agenda both in global and local health promotion. The incidence of diabetes keeps on increasing, unfortunately more than half of the patients being undiagnosed1. Early identification of high-risk individuals, such as those who have impaired glucose tolerance, is one of the strategies to prevent diabetes. Early detection of individuals with pre-diabetes enhanced the implementation of lifestyle modification interventions, and these interventions have been evidenced to prevent progression of pre-diabetes to diabetes2. Fasting plasma glucose has been proposed as the possible tool to identify individuals with high diabetes risk or asymptomatic diabetes1. Nonetheless, it is costly and time consuming. In addition, blood test is an invasive procedure and the result of fasting plasma glucose could only provide one-time-point information (that is, the subjects’ glycemic status at the time when the blood was taken). To increase the acceptability of diabetes screening, Diabetic Risk Score (DRS) has been developed and considered as a practical tool to predict type 2 diabetes risk3. DRS uses certain variables, such as family medical history, personal body measures or blood test results, to estimate the chance of having diabetes either at the current moment or in the next few years. Different DRS have been developed for different populations, for example, Finnish Diabetes Risk Score (FINDRISC)3 for Finnish population, Dundee Coronary Risk Score for English people4, Australian Screening Protocol for Australians4. A recent review concluded that Finnish Diabetes Risk Score (FINDRISC) tool as the best available tool for use in clinical practice due to its simple, fast, inexpensive and non-invasive features4. It was concluded that age, BMI, waist circumference, use of blood pressure medication, history of high blood glucose, physical activity less than 4 hours per week, daily consumption of vegetables or fruits could predict the 10-year risk of diabetes3. FINDRISC has good sensitivity (=0.78), specificity (=0.77) and positive predictive value (=0.13)3. FINDRISC ranges from 0 to 26, and 15 or more is considered as high risk of diabetes in Finnish population5. FINDRISC is considered as a laymen-friendly tool because all the measures can be reported by laymen, and no laboratory data is involved. It is originally designed as a simple paper-and-pencil screening tool that could be used by laymen without training5. Recent study showed that FINDRISC was also the tool for screening different types of pre-diabetes (impaired fasting glucose, impaired glucose tolerance and undetected diabetes)6. FINDRISC is now being used in various European countries including Netherland, France, Italy and Spain. Nonetheless, the application of this tool in Chinese population has never been investigated and the cut-off score of this scale in Chinese population is uncertain. The proliferation of smartphones and its software applications (or apps) has provided a new channel for health promotion. The advantage and convenience of compact size and mobility of smartphones allows users to access health information and tools at any time and at any place that best suits individuals’ pace of living. A research found that 75 million adults in USA used their smartphones for health information and tools7. Among those aged 55 and older who own smartphones or tablets, half of them are using the devices for health purposes7. These apps are designed for clinical assessment, symptom monitoring, health education, resource location, tracking treatment progress, skills training, and two-way communication with health providers8. A wide array of common topic areas such as smoking cessation, sexual and reproductive health, mental health are covered for people of all ages9. A recent systematic review showed that as at 19 June 2012, seven free-of-charge app for assessing the risk of type 2 diabetes were identified, and among these, four used the FINDRISC10 as the logarithm for calculating the risk score, and yet, it has been criticized that FINDRISC was developed for a specific population and when we extrapolating the score to other populations such as Chinese population, validation of the risk score is needed10. In addition, since mobile app can calculate the risk score immediately, a more complex model other than the existing formula used in FINDRISC can be applied10. Thus, it is worthy to develop a modified logarithm for mobile app application based on FINDRISC original logarithm and Chinese people’s lifestyle. The objectives of the proposed study are: to valid the FINDRISC score in Chinese population; and 2) to modify the logarithm of the risk score based on Chinese people’s lifestyle.