Using the AUSDRISK score to screen for pre‐diabetes and diabetes in GP practices: a case‐finding approach

• Published in: Australian and New Zealand Journal of Public Health
• Main Authors: Kerry Fleming, Natasha Weaver, Roseanne Peel, Alexis Hure, Mark McEvoy, Elizabeth Holliday, Martha Parsons, Shamasunder Acharya, Judy Luu, John Wiggers, Chris Rissel, Priyanga Ranasinghe, Ranil Jayawardena, Samir Samman, John Attia
• Format: Article
• Language: English
• Published: Elsevier 2022-04-01
• Subjects: diabetes; pre‐diabetes; prevention; primary care; AUSDRISK
• Online Access: https://doi.org/10.1111/1753-6405.13181

Abstract Objective: To identify the optimal AUSDRISK threshold score to screen for pre‐diabetes and diabetes. Methods: A total of 406 adult patients not diagnosed with diabetes were screened in General Practices (GP) between May and October 2019. All patients received a point of care (POC) HbA1c test. HbA1c test results were categorised into diabetes (≥6.5% or ≥48 mmol/mol), pre‐diabetes (5.7–6.4% or 39–47 mmol/mol), or normal (<5.7% or 39 mmol/mol). Results: Of these patients, 9 (2%) had undiagnosed diabetes and 60 (15%) had pre‐diabetes. A Receiver Operator Characteristic (ROC) curve was constructed to predict the presence of pre‐diabetes and diabetes; the area under the ROC curve was 0.72 (95%CI 0.65–0.78) indicating modest predictive ability. The optimal threshold cut point for AUSDRISK score was 17 (sensitivity 76%, specificity 61%, + likelihood ratio (LR) 1.96, ‐ likelihood ratio of 0.39) while the accepted cut point of 12 performed less well (sensitivity 94%, specificity 23%, +LR=1.22 ‐LR+0.26). Conclusions: The AUSDRISK tool has the potential to be used as a screening tool for pre‐diabetes/diabetes in GP practices. A cut point of ≥17 would potentially identify 75% of all people at risk and three in 10 sent for further testing would be positive for prediabetes or diabetes. Implications for public health: Routine case‐finding in high‐risk patients will enable GPs to intervene early and prevent further public health burden from the sequelae of diabetes.