Diagnostic accuracy of the FINDRISC questionnaire for detecting type 2 diabetes mellitus in an indigenous population from Northeastern Sierra of Puebla, Mexico

Introduction: The Finnish Diabetes Risk Score questionnaire is a widely used tool for screening type 2 diabetes mellitus; however, its application in Indigenous populations has been little studied. This study assessed the diagnostic accuracy of this questionnaire for detecting cases consistent with type 2 diabetes mellitus in the Totonac population of the state of Puebla, Mexico, and its performance when stratified by gender. Methods: A cross-sectional diagnostic accuracy study with prospective data collection was conducted in 148 adults (≥18 years) without a previous diagnosis of type 2 diabetes mellitus. Participants were residents of communities in the Sierra Nororiental of Puebla and were recruited through convenience sampling with consecutive enrollment during a health fair. The Finnish Diabetes Risk Score questionnaire was used as the index test, evaluated using two cutoff points (≥12 and ≥15); glycated hemoglobin (≥6.5%) was used as the reference standard. Both tests were administered independently and with assessor blinding. Sensitivity, specificity, predictive values, diagnostic accuracy, and the area under the curve were estimated through overall and gender-stratified analyses. Results: At the ≥12 cut-off point, the Finnish Diabetes Risk Score showed an overall sensitivity of 76.4% (95%; CI: 66.6 to 84.0), specificity of 55.9% (95%; CI: 43.3 to 67.9), diagnostic accuracy of 68.2% (95%; CI: 60.4 to 75.2), and an area under the curve of 0.64 (95%; CI: 0.54 to 0.73). In women, sensitivity reached 85.2% (95%; CI: 73.4 to 92.3) and the area under the curve was 0.71 (95%; CI: 0.60 to 0.81), whereas in men the discriminative capacity was limited. Conclusions: The Finnish Diabetes Risk Score questionnaire demonstrated moderate discriminative capacity for detecting cases compatible with type 2 diabetes mellitus in the Totonac Indigenous population, with acceptable performance in women using the cut-off point of ≥12. These findings support its use as an initial screening tool in settings with limited access to confirmatory tests and highlight the need for validation in specific contexts.