Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18–69 years

Abstract

Background The application of risk scores has often effectively predicted undiagnosed type 2 diabetes in a non-invasive way to guide early clinical management. The capacity for diagnosing diabetes in developing countries including Kenya is limited. Screening tools to identify those at risk and thus target the use of limited resources could be helpful, but these are not validated for use in these settings. We, therefore, aimed to measure the performance of the Finnish diabetes risk score (FINDRISC) as a screening tool to detect undiagnosed diabetes among Kenyan adults. Methods A nationwide cross-sectional survey on non-communicable disease risk factors was conducted among Kenyan adults between April and June 2015. Diabetes mellitus was defined as fasting capillary whole blood ≥ 7.0mmol/l. The performance of the original, modified, and simplified FINDRISC tools in predicting undiagnosed diabetes was assessed using the area under the receiver operating curve (AU-ROC). Non-parametric analyses of the AU-ROC, Sensitivity (Se), and Specificity (Sp) of FINDRISC tools were determined. Results A total of 4,027 data observations of individuals aged 18−69 years were analyzed. The proportion/prevalence of undiagnosed diabetes and prediabetes was 1.8% [1.3–2.6], and 2.6% [1.9–3.4] respectively. The AU-ROC of the modified FINDRISC and simplified FINDRISC in detecting undiagnosed diabetes were 0.7481 and 0.7486 respectively, with no statistically significant difference (p = 0.912). With an optimal cut-off ≥ 7, the simplified FINDRISC had a higher positive predictive value (PPV) (7.9%) and diagnostic odds (OR:6.65, 95%CI: 4.43–9.96) of detecting undiagnosed diabetes than the modified FINDRISC. Conclusion The simple, non-invasive modified, and simplified FINDRISC tools performed well in detecting undiagnosed diabetes and may be useful in the Kenyan population and other similar population settings. For resource-constrained settings like the Kenyan settings, the simplified FINDRISC is preferred.