Fig. 1Receiver operating characteristic curves of various risk scores for diagnosis of undiagnosed diabetes. AMCDRS, Achutha Menon Centre Diabetes Risk Score; IDRS, Indian Diabetes Risk Score.
Fig. 2Receiver operating characteristic curves of various risk scores for diagnosis of total diabetes. AMCDRS, Achutha Menon Centre Diabetes Risk Score; IDRS, Indian Diabetes Risk Score.
Table 1Validity of the Achutha Menon Centre Diabetes Risk Score for predicting prevalent diabetes
Cut-off score |
Sensitivity, % |
Specificity, % |
PPV, % |
NPV, % |
Validity of score for predicting prevalent undiagnosed diabetes |
6 and above |
1.8 |
98.8 |
9.3 |
93.8 |
5 and above |
24.5 |
87.1 |
11.1 |
94.6 |
4 and abovea
|
59.5 |
60.5 |
9.1 |
95.8 |
3 and above |
86.5 |
31.8 |
7.7 |
97.3 |
2 and above |
97.4 |
14.5 |
7.0 |
98.8 |
Validity of score for predicting prevalent total diabetes (diagnosed and undiagnosed) |
6 and above |
5.8 |
98.8 |
47.3 |
85.1 |
5 and above |
40.4 |
87.1 |
36.5 |
88.9 |
4 and abovea
|
75.1 |
60.5 |
25.9 |
93 |
3 and above |
92.6 |
31.8 |
19.9 |
95.9 |
2 and above |
98.6 |
14.5 |
17.5 |
98.2 |
Table 2Validity of other risk scores from India, in predicting prevalent diabetes
Risk score |
Sensitivity, % |
Specificity, % |
PPV, % |
NPV, % |
Validity of score for predicting prevalent undiagnosed diabetes |
IDRS |
59.1 |
59.4 |
8.9 |
95.6 |
Ramachandran score |
77.4 |
45.2 |
8.6 |
96.8 |
Chaturvedi score |
66.8 |
63.0 |
10.7 |
96.6 |
Validity of score for predicting prevalent total diabetes (diagnosed and undiagnosed) |
IDRS |
69.1 |
59.3 |
23.9 |
91.2 |
Ramachandran score |
83.4 |
45.2 |
21.9 |
93.7 |
Chaturvedi score |
75.9 |
63.0 |
27.3 |
93.4 |
Table 3Cost per case detected for universal screening versus risk score followed by confirmation
|
Screening with FPG |
AMCDRSa |
IDRSa |
Chaturvedi scorea |
Ramachandran scorea |
No. of units |
Total costs, US$ (95%CI) |
No. of units |
Total costs, US$ (95%CI) |
No. of units |
Total costs, US$ (95%CI) |
No. of units |
Total costs, US$ (95%CI) |
No. of units |
Total costs, US$ (95%CI) |
Materialsb, unit cost (range) |
|
|
|
|
|
|
|
|
|
|
Questionnaire, $0.05 (0.04–0.07) |
0 |
0 |
4,411 |
220.6 (176.4–308.8) |
4,362 |
218.1 (174.5–305.3) |
4,411 |
220.6 (176.4–308.8) |
4,396 |
219.8 (175.8–307.7) |
FPG, $2.44 (1.71–3.17) |
4,411 |
10762.8 (7,542.8–13,982.9) |
1,798 |
4387.1 (3,074.6–5,699.7) |
1,824 |
4450.6 (3,119.0–5,782.1) |
1,715 |
4184.6 (2,932.7–5,436.6) |
2,469 |
6024.4 (4,221.9–7,826.7) |
Cost of strategyc
|
|
10762.8 (7,542.8–13,982.9) |
|
4607.7 (3,251.0–6,008.5) |
|
4668.7 (3,293.5–6,087.4) |
|
4405.2 (3,109.1–5,745.4) |
|
6,244.2 (4,397.7–8,134.4) |
Score positives sent for FPG |
- |
|
1,798 |
|
1,824 |
|
1,715 |
|
2,469 |
|
FPG ≥126 mg/dL (diabetes) |
274 |
|
163 |
|
162 |
|
183 |
|
212 |
|
No. needed to screen |
16 |
|
27 |
|
27 |
|
24 |
|
21 |
|
Cost/person screened |
2.44 (1.71–3.17) |
1.04 (0.74–1.36) |
1.07 (0.76–1.39) |
0.99 (0.70–1.30) |
1.40 (1.00–1.85) |
Cost/confirmed case |
39.2 (27.5–51.0) |
28.3 (19.9–36.9) |
28.8 (20.3–37.6) |
24.1 (16.9–31.4) |
29.5 (20.7–38.4) |