Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care

Abstract Aims To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. Methods Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126 mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed. Results In both regions, the valid cut-off point for diabetes (DIABSCORE = 100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7–31.5) in Canarian and 18.3 (8.0–51.1) in Valencian; and for glucose ≥126 mg/dL it was, respectively, 123.0 (58.8–259.2) and 303.1 (162.5–583.8). However, glucose ≥126 mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126 mg/dL (10.8 € and 10.5 €, respectively). Conclusions DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.