Applicability of ADA Diabetes Risk Scoring System in the Indian Population

Background: Screening model-based risk stratification tools, such as American Diabetes Association (ADA) diabetes risk scoring are useful in increasing awareness toward one’s risk of developing Diabetes mellitus (DM) or prediabetes. The application of ADA risk score in the Asian population might have limitations. Objective: To evaluate (a) the scope of the existing ADA score in screening Indian population and (b) the incorporation of epidemiologically relevant factors in enhancing the sensitivity of the scoring system for a population-wide screen. Methods: A prospective observational study was conducted among adults with normoglycemia, a history of T2DM or prediabetes. Diabetes risk scores, with and without modifications of factors including age, BMI, and abdominal obesity based on Indian-specific criteria were calculated. The sensitivity was evaluated after incorporating each modification and with simultaneous incorporation of all modifications (Bharat Risk Score for Dysglycemia [BRS-D] scoring system). Results: Among 723 individuals screened, 101 participants had a history of DM, and 18 participants without a history of diabetes had a capillary glucose level ≥200 mg/dl. The sensitivity of the ADA scoring system with the standard ADA score (≥5) was 86.6%. With the inclusion of the modifications, the sensitivity of the scoring system increased: 91.6% (age), 90.8% (waist circumference) and 89.1% (BMI), 93.3% (all modifications). Conclusion: The application of population-specific criteria to the standard ADA scoring system could improve sensitivity. The proposed BRS-D scoring system can be a versatile tool that will enable large-scale screening to identify high-risk individuals for diabetes among, the Indian population.