Excerpt
Type 2 diabetes has now become a global health problem threatening the lives of millions of people. According to the latest Diabetes Atlas 5, released on 14th November 2011 by the International Diabetes Federation (IDF), there are currently 366 million people with diabetes globally and this is predicted to increase to 552 million by the year 2030 [
1]. Unfortunately, type 2 diabetes is a silent disease. In the Chennai Urban and Rural Epidemiology Study (CURES), it was shown that the “Rule of Halves” is very much valid in the case of diabetes [
2] just as in the case of hypertension [
3]. Thus, half of those with type 2 diabetes in the community remain undiagnosed, of those diagnosed, less than half receive treatment and of those who take treatment, less than half have their diabetes under control [
2]. One of the challenges for physicians and diabetologists therefore, is to detect undiagnosed type 2 diabetes in the community. Obviously, one way to do it is to screen everyone in the population for the disorder. In a country like India, however, this is not feasible due to sheer numbers of people with diabetes. According to the recent ICMR –INDIAB study, there are an estimated 62.4 million people with diabetes and 77 million people with pre-diabetes [
4]. Hence the challenges of screening 1.2 billion Indians to identify all those with diabetes and pre-diabetes can well be imagined. There is therefore a need to develop simple tools to cost effectively identify type 2 diabetes in the population. This led to the establishment of several risk scores for diabetes such as the American Diabetes Association Risk Score [
5] Finnish Diabetes Risk Score [
6], German Diabetes Risk Score [
7], Danish Diabetes Risk Score [
8] Cambridge Risk Score [
9] and the Spanish Risk Score [
10]. Within India also different risk scores have been described based on population based studies [
11,
12]. It has been shown that the Indian Diabetes Risk Score (IDRS) is useful not only to predict undiagnosed diabetes in the community [
11] but also to predict incident diabetes [
13], to classify the type of diabetes [
14] and even to predict individuals who may have certain complications of diabetes like peripheral vascular disease and neuropathy [
15]. The IDRS also serves as an effective indicator of metabolic syndrome and cardiovascular risk even among subjects with normal glucose tolerance [
16]. Use of IDRS is more effective and less expensive than genotyping and makes it less costly than universal OGTT screening of the whole population to detect subjects with type 2 diabetes in India [
17]. Thus it is clear that diabetes risk scores have come to stay, and if used judiciously, can lead to cost effective screening of diabetes. …
