Diabetes Metab J.  2022 Mar;46(2):273-285. 10.4093/dmj.2021.0054.

Performance of Diabetes and Kidney Disease Screening Scores in Contemporary United States and Korean Populations

• Meng L
• Kwon KS
• Kim DJ
• Lee Yh
• Kim J
• Kshirsagar AV
• Bang H

• KMID: 2527720
• DOI: http://doi.org/10.4093/dmj.2021.0054

Abstract

Background
Risk assessment tools have been actively studied, and they summarize key predictors with relative weights/importance for a disease. Currently, standardized screening scores for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD)—two key global health problems—are available in United States and Korea. We aimed to compare and evaluate screening scores for DM (or combined with prediabetes) and CKD, and assess the risk in contemporary United States and Korean populations.
Methods
Four (2×2) models were evaluated in the United States-National Health and Nutrition Examination Survey (NHANES 2015–2018) and Korea-NHANES (2016–2018)—8,928 and 16,209 adults. Weighted statistics were used to describe population characteristics. We used logistic regression for predictors in the models to assess associations with study outcomes (undiagnosed DM and CKD) and diagnostic measures for temporal and cross-validation.
Results
Korean adult population (mean age 47.5 years) appeared to be healthier than United States counterpart, in terms of DM and CKD risks and associated factors, with exceptions of undiagnosed DM, prediabetes and prehypertension. Models performed well in own country and external populations regarding predictor-outcome association and discrimination. Risk tests (high vs. low) showed area under the curve >0.75, sensitivity >84%, specificity >45%, positive predictive value >8%, and negative predictive value >99%. Discrimination was better for DM, compared to the combined outcome of DM and prediabetes, and excellent for CKD due to age.
Conclusion
Four easy-to-use screening scores for DM and CKD are well-validated in contemporary United States and Korean populations. Prevention of DM and CKD may serve as first-step in public health, with these self-assessment tools as basic tools to help health education and disparity.

Keyword

Diabetes mellitus, type 2; Prediabetic state; Renal insufficiency, chronic; Risk factors; Self-assessment

Figure

• 

  I (x) denotes indicator function; if condition x is met, score 1; and score 0 otherwise. For DM scores, 5 or higher score means “at high risk.” For CKD scores, 4 or higher score means “at high risk.” Currently, United States uses the same risk score for DM and pre-DM, and Korea does not have a widely used pre-DM score. Paper version of the questionnaire provides a user-friendly sub-table for BMI/obesity categories based on weight and height. Similarly, online calculators only ask for weight and height.

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