Risk assessment tools for identifying individuals at risk of developing type 2 diabetes.
Risk assessment tools for identifying individuals at risk of developing type 2 diabetes.
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DOI：
10.1093/epirev/mxq019
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发表时间：
2011
影响因子：
5.5
通讯作者：
Schulze MB
中科院分区：
文献类型：
--
作者：
Buijsse B;Simmons RK;Griffin SJ;Schulze MB
试验已经证明，在糖耐量受损的人群中，通过改变生活方式或药物可以预防2型糖尿病。然而，需要其他方法来识别有患糖尿病风险的人。为此目的开发了多变量风险评分。本文通过1)系统地回顾现有评分的文献，2)在外部人群中验证糖尿病风险评分在成人中的表现；3)探索围绕风险评分的开发、验证和比较的方法学问题。风险评分显示，在为其开发的人群中，总体上具有良好的区分能力。然而，在外部人群中，歧视性表现的异质性更大，而且通常较弱，这表明风险评分可能需要在打算使用它们的人群中进行验证。风险评分是否能够准确估计绝对风险仍然未知；因此，在使用评分向个体传达绝对糖尿病风险时需要谨慎。一些风险评分基于常规的非侵入性测量或问卷调查的数据来预测糖尿病的风险。生化指标，特别是空腹血糖，可以改善这类模型的预测。另一方面，基因图谱的实用性目前似乎有限。
Trials have demonstrated the preventability of type 2 diabetes through lifestyle modifications or drugs in people with impaired glucose tolerance. However, alternative ways of identifying people at risk of developing diabetes are required. Multivariate risk scores have been developed for this purpose. This article examines the evidence for performance of diabetes risk scores in adults by 1) systematically reviewing the literature on available scores and 2) their validation in external populations; and 3) exploring methodological issues surrounding the development, validation, and comparison of risk scores. Risk scores show overall good discriminatory ability in populations for whom they were developed. However, discriminatory performance is more heterogeneous and generally weaker in external populations, which suggests that risk scores may need to be validated within the population in which they are intended to be used. Whether risk scores enable accurate estimation of absolute risk remains unknown; thus, care is needed when using scores to communicate absolute diabetes risk to individuals. Several risk scores predict diabetes risk based on routine noninvasive measures or on data from questionnaires. Biochemical measures, in particular fasting plasma glucose, can improve prediction of such models. On the other hand, usefulness of genetic profiling currently appears limited.
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