Identification of undiagnosed type 2 diabetic individuals by the finnish diabetes risk score and biochemical and genetic markers: a population-based study of 7232 Finnish men.

Background: The Finnish Diabetes Risk Score (FINDRISC) is a well established method to evaluate the risk of type 2 diabetes. However, it is unknown whether biochemical markers or confirmed type 2 diabetes risk genes improve the risk evaluation beyond the FINDRISC.
Objective: We investigated the role of biochemical markers and type 2 diabetes risk loci in the identification of previously undiagnosed diabetic subjects beyond the FINDRISC in a cross-sectional study.
Research Design and Methods: A random sample of 7232 Finnish men aged 45-74 yr (including 518 men with new type 2 diabetes) participated in the study. Insulin sensitivity and insulin secretion were evaluated by oral glucose tolerance test-derived indices. Total triglycerides, high-density lipoprotein cholesterol, adiponectin, and alanine transaminase were measured. Nineteen type 2 diabetes risk single-nucleotide polymorphisms were genotyped.
Results: FINDRISC was the best single indicator of prevalent undiagnosed diabetes among all variables tested and strongly associated with insulin resistance. It was also more strongly associated with insulin secretion compared with the type 2 risk alleles. The receiver operating characteristics area under the curve based on logistic regression models for the identification of previously undiagnosed type 2 diabetic subjects with the FINDRISC alone was 0.727, and 0.772 after adding total triglycerides, high-density lipoprotein cholesterol, adiponectin, and alanine transaminase in the model. Adding type 2 risk alleles did not further improve the model (0.772).
Conclusions: Biochemical markers, but not genetic markers, improve the identification of previously undiagnosed type 2 diabetes beyond the FINDRISC alone.