Identifying young adults at high risk of prediabetes and diabetes using the German diabetes risk score and fasting plasma glucose

Abstract

Background: Prediabetes, the leading risk factor for type two diabetes mellitus, represents the intermediate glycaemic stage between normal glycaemia and clinical diabetes. Since the prevalence of type two diabetes mellitus has been increasing, importance is given to monitor the prevalence of prediabetes especially in the younger segment. Aim: To quantify the risk of prediabetes by using a risk tool incorporating its risk factors. This study also sought to assess the validity and reliability of a risk tool on the local population. Fasting plasma glucose was collected to further assess prediabetes risk and compared to the risk score. Research Design and Method: A cross-sectional, correlational, study was conducted. Convenience sampling was used with a target sample size of 374. 176 young adults aged 18-35 years attending either the University of Malta or the Malta College of Arts, Science and Technology had their data collected from the 22 nd of December, 2020 up until the 30th of April, 2021. 57 of these participants also attended for fasting plasma glucose tests after fasting for at least 8 hours. Data analysis was carried out using IBM® SPSS® Statistics Version 27. The Kolmogorov-Smirnov and Shapiro-Wilk test, Mann-Whitney U test, Pearson and Spearman correlation, Fisher’s exact test, Univariate General Linear Model and the receiver operating characteristic analysis were all used to analyse the data. Results: 5.3% (n=3) of participants obtained an abnormal fasting plasma glucose value (≥5.6 mmol/L), signifying prediabetes. One of these three participants also satisfied the criteria for type 2 diabetes mellitus (8.57 mmol/L). The participants who obtained an abnormal fasting plasma glucose value were all male, thus suggesting a higher prevalence of prediabetes in males. The risk factors mostly associated with prediabetes as shown by the German Diabetes Risk Score were sibling history of diabetes, the occurrence of high blood pressure, waist circumference and smoking status. The area under the ROC curve of the German Diabetes Risk Score resulted in 0.787, with a sensitivity of 66.6% and a specificity of 78.0% when scoring 30 points. Conclusion: The utilisation of the German Diabetes Risk Score in young adults in a south European high risk population identified was not shown to be useful in the identification of those subjects with prediabetes or indeed diabetes. The low respondent rate and resultant small sample size undoubtedly contributed to this. The utilisation of fasting plasma glucose to identify such subjects appears to be superior and further studies are needed to investigate the feasibility of nationwide screening in this high risk Maltese population.