Key result
Combining CDRS and fasting CBG optimizes undiagnosed diabetes screening with an AUC of ~0.88.
Why the study?
A practical screening strategy integrating fasting capillary blood glucose with the Chinese Diabetes Risk Score was needed for undiagnosed diabetes in primary care.
Does integrating fasting capillary blood glucose with the Chinese Diabetes Risk Score improve screening accuracy for undiagnosed diabetes in primary care?
Cohort (n=70,252)
Yes
Does integrating fasting capillary blood glucose with the Chinese Diabetes Risk Score improve screening accuracy for undiagnosed diabetes in primary care?
Effect estimate: AUC 0.876
Integrating fasting capillary blood glucose with the Chinese Diabetes Risk Score significantly enhances the accuracy of screening for undiagnosed diabetes in primary care settings.
May support combined screening in primary care; leaves open prospective validation before practice change.
Introduction and Objective: To develop and validate a practical screening strategy integrating fasting capillary blood glucose (CBG) with the Chinese Diabetes Risk Score (CDRS) for undiagnosed diabetes in primary care. Methods: Diabetes Prevention and Control Center (DPCC) project data (aged 35-75) from exploratory (Pingjiang County, n=41,156) and validation cohort (Yuetang County, n=29,096) were used. OGTT was the diagnostic standard. CDRS cut-off was ≥25 per national guidelines. Optimal fasting CBG cut-off was determined via ROC analysis. Diagnostic performance and subgroup analyses were conducted. Results: In the exploratory cohort, CDRS alone showed high sensitivity and low specificity (AUC=0.528). The optimal fasting CBG cut-off was 6.45 mmol/L (AUC=0.824), with 6.4 chosen for validation. The logistic model achieved AUC=0.826. In validation, CDRS alone and CBG alone had limited performance. Parallel strategy (CDRS≥25 or CBG≥6.4 mmol/L) had 96.4% sensitivity (13.7% specificity); the serial strategy had 88.5% specificity (67.9% sensitivity). Notably, the logistic regression model showed optimal balanced performance (AUC=0.876) with consistent subgroup results. Conclusion: Integrating CDRS with fasting CBG enhances undiagnosed diabetes screening accuracy in primary care. The logistic regression model provides balanced performance, offering a simple and practical screening tool. Disclosure X. Tang: None. W. Zhang: None. Z. Wang: None. Z. Zhou: None. Funding The Science and Technology Innovation Program of Hunan Province (2021JC0003, 2022RC1010, 2023SK2027, 2024RC3059)
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TANG et al. (2026) conducted a cohort in Undiagnosed diabetes (n=70,252). Integration of fasting capillary blood glucose with the Chinese Diabetes Risk Score vs. CDRS alone or CBG alone was evaluated on Diagnostic accuracy for undiagnosed diabetes (AUC 0.876). A logistic regression model integrating the Chinese Diabetes Risk Score with fasting capillary blood glucose achieved optimal balanced performance for screening undiagnosed diabetes (AUC=0.876).
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