Improvements in ability to detect undiagnosed diabetes by using information on family history among adults in the United States - PubMed (original) (raw)

Comparative Study

. 2010 May 15;171(10):1079-89.

doi: 10.1093/aje/kwq026. Epub 2010 Apr 25.

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Comparative Study

Improvements in ability to detect undiagnosed diabetes by using information on family history among adults in the United States

Quanhe Yang et al. Am J Epidemiol. 2010.

Abstract

Family history is an independent risk factor for diabetes, but it is not clear how much adding family history to other known risk factors would improve detection of undiagnosed diabetes in a population. Using the National Health and Nutrition Examination Survey for 1999-2004, the authors compared logistic regression models with established risk factors (model 1) with a model (model 2) that also included familial risk of diabetes (average, moderate, and high). Adjusted odds ratios for undiagnosed diabetes, using average familial risk as referent, were 1.7 (95% confidence interval (CI): 1.2, 2.5) and 3.8 (95% CI: 2.2, 6.3) for those with moderate and high familial risk, respectively. Model 2 was superior to model 1 in detecting undiagnosed diabetes, as reflected by several significant improvements, including weighted C statistics of 0.826 versus 0.842 (bootstrap P = 0.001) and integrated discrimination improvement of 0.012 (95% CI: 0.004, 0.030). With a risk threshold of 7.3% (sensitivity of 40% based on model 1), adding family history would identify an additional 620,000 (95% CI: 221,100, 1,020,000) cases without a significant change in false-positive fraction. Study findings suggest that adding family history of diabetes can provide significant improvements in detecting undiagnosed diabetes in the US population. Further research is needed to validate the authors' findings.

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Figures

Figure 1.

Figure 1.

Weighted predictiveness curves (A) and true-positive fraction (TPF) and false-positive fraction (FPF, 1 − specificity) (B) for model with selected risk factors (model 1) and model with selected risk factors plus family history of diabetes (model 2), National Health and Nutrition Examination Survey, 1999–2004. The horizontal dashed line in A indicates the prevalence of undiagnosed diabetes in the population (2.9%).

Figure 2.

Figure 2.

Weighted decision curves for models predicting undiagnosed diabetes using models with family history of diabetes (solid line) and without this history (small dashed line), National Health and Nutrition Examination Survey, 1999–2004. The dash-dot-dot-dash line indicates the net benefit of testing all people, and the horizontal dashed line indicates testing none of the people. The y axis indicates the number of true cases identified per 100 people.

References

    1. Yoon PW, Scheuner MT, Khoury MJ. Research priorities for evaluating family history in the prevention of common chronic diseases. Am J Prev Med. 2003;24(2):128–135. - PubMed
    1. Guttmacher AE, Collins FS, Carmona RH. The family history—more important than ever. N Engl J Med. 2004;351(22):2333–2336. - PubMed
    1. Yoon PW, Scheuner MT, Peterson-Oehlke KL, et al. Can family history be used as a tool for public health and preventive medicine? Genet Med. 2002;4(4):304–310. - PubMed
    1. Rich EC, Burke W, Heaton CJ, et al. Reconsidering the family history in primary care. J Gen Intern Med. 2004;19(3):273–280. - PMC - PubMed
    1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31(3):596–615. - PubMed

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