We note that Gillies et al in their paper on ‘Different strategies
for screening and prevention of type 2 diabetes in adults: cost
effectiveness analysis’ did not refer to the use the FINDRISK tool to
predict the risk of type 2 diabetes. This diabetes risk test has eight
questions and a score of >15 indicates a one-in-three chance of
developing type 2 diabetes within 10 years. Assessed against two
population cohorts, the test has shown sensitivity of 0.78 and 0.81,
specificity of 0.77 and 0.76, and positive predicted value of 0.13 and
0.05. The test can be self-administered via the website or handed out by
health service providers as demonstrated in two real-world implementation
trials in Finland and Australia. , In our experience this diabetes risk
test is simple to use, and substantially reduces the number of people who
need to be screened by subsequent fasting glucose or oral glucose
tolerance tests, thereby reducing the cost of public health prevention
programs for diabetes. Our recent studies showed that half of those
identified at risk using this test were willing to join a group lifestyle
intervention that reduced the risk of diabetes by 40%, the prevalence of
metabolic syndrome from 60% to 45%, and all CVD risks by 16%.4 The health
economic calculations indicate a cost of approximately A$2,000 per
disability adjusted life year, which makes this an inexpensive public
health intervention. Work is underway to calibrate the FINDRISK test for
culturally and linguistically diverse groups in Australia.
Clare L Gillies, Paul C Lambert, Keith R Abrams, Alex J Sutton,
Nicola J Cooper, Ron T Hsu, Melanie J Davies, Kamlesh Khunti. Different
strategies for screening and prevention of type 2 diabetes in adults: cost
effectiveness analysis. BMJ. doi:10.1136/bmj.39545.585259.25.
Lindstrom J, Tuomilehto J. The Diabetes Risk Score: A practical tool
to predict type 2 diabetes risk. Diabetes Care. 2003; 26:725-731.
Absetz Pilviki, Valve Raisa, Oldenburg Brian, Heinonen Heikki,
Nissinen Aulikki, Fogelholm Mikael, Ilvesmaki Vesa, Talja Martti, Uutela
Antti. Type 2 diabetes prevention in the “Real World”. One-year results of
the GOAL Implementation Trual. Diabetes Care. 2007; 30:2465-2470.
LaatikainenT, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E,
Heistaro S, Philpot B, Absetz P, Bunker S, O’Neil A, Reddy P, Best JD,
Janus ED. Prevention of Type 2 Diabetes by lifestyle intervention in an
Australian primary health care setting: Greater Green Triangle (GGT)
Diabetes Prevention Project. BMC Public Health 2007; 7 (147):249
Competing interests:
None declared
Competing interests:
No competing interests
06 May 2008
James A Dunbar
Director
Prasuna Reddy, Edward Janus, Brian Oldenburg, Rob Carter
Greater Green Triangle UDRH, Flinders and Deakin Universities, Warrnambool, Vic 3280 Australia.
Rapid Response:
Using the FINDRISK tool lowers the cost
We note that Gillies et al in their paper on ‘Different strategies
for screening and prevention of type 2 diabetes in adults: cost
effectiveness analysis’ did not refer to the use the FINDRISK tool to
predict the risk of type 2 diabetes. This diabetes risk test has eight
questions and a score of >15 indicates a one-in-three chance of
developing type 2 diabetes within 10 years. Assessed against two
population cohorts, the test has shown sensitivity of 0.78 and 0.81,
specificity of 0.77 and 0.76, and positive predicted value of 0.13 and
0.05. The test can be self-administered via the website or handed out by
health service providers as demonstrated in two real-world implementation
trials in Finland and Australia. , In our experience this diabetes risk
test is simple to use, and substantially reduces the number of people who
need to be screened by subsequent fasting glucose or oral glucose
tolerance tests, thereby reducing the cost of public health prevention
programs for diabetes. Our recent studies showed that half of those
identified at risk using this test were willing to join a group lifestyle
intervention that reduced the risk of diabetes by 40%, the prevalence of
metabolic syndrome from 60% to 45%, and all CVD risks by 16%.4 The health
economic calculations indicate a cost of approximately A$2,000 per
disability adjusted life year, which makes this an inexpensive public
health intervention. Work is underway to calibrate the FINDRISK test for
culturally and linguistically diverse groups in Australia.
Clare L Gillies, Paul C Lambert, Keith R Abrams, Alex J Sutton,
Nicola J Cooper, Ron T Hsu, Melanie J Davies, Kamlesh Khunti. Different
strategies for screening and prevention of type 2 diabetes in adults: cost
effectiveness analysis. BMJ. doi:10.1136/bmj.39545.585259.25.
Lindstrom J, Tuomilehto J. The Diabetes Risk Score: A practical tool
to predict type 2 diabetes risk. Diabetes Care. 2003; 26:725-731.
Absetz Pilviki, Valve Raisa, Oldenburg Brian, Heinonen Heikki,
Nissinen Aulikki, Fogelholm Mikael, Ilvesmaki Vesa, Talja Martti, Uutela
Antti. Type 2 diabetes prevention in the “Real World”. One-year results of
the GOAL Implementation Trual. Diabetes Care. 2007; 30:2465-2470.
LaatikainenT, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E,
Heistaro S, Philpot B, Absetz P, Bunker S, O’Neil A, Reddy P, Best JD,
Janus ED. Prevention of Type 2 Diabetes by lifestyle intervention in an
Australian primary health care setting: Greater Green Triangle (GGT)
Diabetes Prevention Project. BMC Public Health 2007; 7 (147):249
Competing interests:
None declared
Competing interests: No competing interests