Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15)

Abstract

Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India.

Methods: Data were acquired from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS.

Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions.

Interpretation & conclusions: Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.

Keywords: Asian Indians; Indian Diabetes Risk Score; high-risk group; screening; type 2 diabetes; undiagnosed diabetes.

Fig. 1

ROC curve showing the performance of MDRF-IDRS among the (A) urban and (B) rural population in diagnosing diabetes. ROC, receiver operating characteristic; MDRF-IDRS, Madras Diabetes Research Foundation-Indian Diabetes Risk Score.

Fig. 2

ROC curve showing the performance of MDRF-IDRS among (A) male and (B) female population in diagnosing diabetes. ROC, receiver operating characteristic; MDRF-IDRS, Madras Diabetes Research Foundation-Indian Diabetes Risk Score.

Fig. S1

The Indian Council of Medical Research–INdia DIABetes sampling strategy. Source26. ICMR–INDIAB, Indian Council of Medical Research–INdia DIABetes.

Fig. S2

The Indian Council of Medical Research–INdia DIABetes sampling framework in rural areas. Source26. ICMR–INDIAB, Indian Council of Medical Research–INdia DIABetes; UT, union territory; PPS, probability proportional to population size.

Fig. S3

The Indian Council of Medical Research–INdia DIABetes sampling framework in urban areas. Source26. ICMR–INDIAB, Indian Council of Medical Research–INdia DIABetes; UT, union territory.