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    Patent Pending

    Australian Type 2 Diabetes Risk (AUSDRISK) Assessment Tool

    Estimates risk of developing type 2 diabetes, mainly in Australian patients.
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    INSTRUCTIONS

    Not for use in people with diagnosed diabetes. Use for screening in adults ≥25 years of age.

    Note: BMI, waist circumference, or both may be used as the obesity parameter. The study's authors recommend using waist circumference only, as it has the greatest discriminatory power.

    When to Use
    Pearls/Pitfalls
    Why Use

    Primary care lifestyle screening for adults ≥25 years of age.

    • The Australian Type 2 Diabetes Risk (AUSDRISK) Assessment Tool identifies Australian adults at high risk for developing diabetes based on demographic, lifestyle, and simple anthropometric measures.
    • Targeted for use in primary care screening.
    • Enables identification of high risk individuals for focused lifestyle counseling and/or further investigation.
    • Developed specifically for the Australian population but has allowance for ethnicity and country of birth, so it may have validity in other countries with similar demographics.
    • Has been validated in a separate study examining an external cohort of Dutch patients.
    • May overestimate risk in patients <25 years.
    • Some versions of the AUSDRISK eliminate BMI, but the authors found that it resulted in a loss of discriminatory power.
    • Includes only non-invasive variables.
    • Provides objective score to help support recommendations of lifestyle modification to patients by primary care physicians.
    • In identified high-risk patients, enables further investigation and appropriate management of risk and lifestyle factors to prevent the development of diabetes.
    • In Australia, AUSDRISK score ≥12 is a prerequisite for physician access to Medicare items for health assessment of patients in the 40-49 age group.
    in
    About the Creator
    Dr. Lei Chen
    Content Contributors
    • Stuart McMaster, MBChB
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    • In Australia, patients with scores ≥12 should be investigated for possible diabetes and enrolled for advice regarding diet, weight control, and exercise.

    Diagnostic criteria for diabetes (Australia):

      • Fasting blood glucose (FBG) ≥7.0 mmol/L, confirmed by a second reading on a separate day OR
      • Oral glucose tolerance test (OGTT) showing FBG ≥7.0 mmol/L or 2-hour blood glucose ≥11.1mmol/L OR
      • Hemoglobin A1c (HgbA1c) ≥48 mmol/mol (6.5%) on two separate occasions.

    Critical Actions

    Monitor for symptomatic diabetes (e.g. polyuria, polydipsia, loss of sensation).

    Formula

     

    Variable

    Points

    Age

    25-34

    35-44

    45-54

    55-64

    ≥65

    0

    2

    4

    6

    8

    Sex

    Female

    Male

    0

    3

    Ethnicity

    Also used to determine waist circumference categories; see below

    Southern European

    Asian

    Aboriginal/Torres Strait Islander

    Pacific Islander

    Other

    2

    2

    2

    2

    0

    Parental history of diabetes

    No

    Yes

    0

    3

    History of high blood glucose*

    No

    Yes

    0

    6

    Use of antihypertensive medications

    No

    Yes

    0

    2

    Current smoker

    No

    Yes

    0

    2

    Physical inactivity**

    No

    Yes

    0

    2

    Waist circumference***

    Category 1

    Category 2

    Category 3

    0

    4

    7

    BMI

    Note: In the study, several models were tested in terms of quantifying obesity; per first author Dr. Lei Chen, the addition of BMI does not significantly increase discriminatory power (see Creator Insights for further detail), but may be used in cases where waist circumference cannot be accurately measured.

    Normal (<25)

    Overweight (25 to less than 30)

    Obese (30 to less than 35)

    Morbidly obese (≥35)

    0

    3

    6

    8

    *Patients were asked if they had ever been told their glucose level was high, including during pregnancy for women.

    **Physical inactivity was defined as less than 150 minutes per week of walking (if continuous and ≥10 minutes) and/or moderate or vigorous activity.

    ***For Aboriginal/Torres Strait Islander or Asian background:

    • Category 1: <90 cm (men), <80 cm (women)
    • Category 2: 90–99 cm (men), 80–89 cm (women)
    • Category 3: ≥100 cm (men), ≥90 cm (women)

    For Southern European, Pacific Islander, or other:

    • Category 1: <102 cm (men), <88 cm (women)
    • Category 2: 102–109 cm (men),  88–99 cm (women)
    • Category 3: ≥110 cm (men), ≥100 cm (women)

    From Chen 2010.

    Facts & Figures

     

    AUSDRISK Score

    5-year Risk* of Type 2 DM

    <5

    1 in 100

    6-8

    1 in 50

    9-11

    1 in 30

    12-15

    1 in 14

    16-19

    1 in 7

    >20

    1 in 3


    May overestimate risk in patients <25 years old and may underestimate risk in Aboriginal and Torres Strait Islanders.

    From General Practice Management Guidelines of Type 2 DM, Royal Australian College of General Practitioners 2016.

    Evidence Appraisal

    The Australian Type 2 Diabetes Risk (AUSDRISK) Assessment Tool was developed by the Baker IDI Heart and Diabetes Institute on behalf of the Australian state and territory governments as part of the Council of Australian Governments (COAG) Reducing the Diabetes Risk initiative, and the derivation study by Chen et al was published in 2010.  This study was a 5-year follow up of 6,060 non-diabetic participants in the Australian Diabetes and Lifestyle study (Dunstan 2002).

    Incident diabetes at follow up was the outcome measure and a risk prediction model was developed by analyzing various demographic and health measurements of the study subjects using logistic regression.

    The prediction model was then converted to a score, which was validated in two independent Australian cohorts.

    Using a score of ≥12 , the sensitivity, specificity, and positive predictive value for identifying incident diabetes over the 5 year study period were 74.0%, 67.7%, and 12.7% respectively. Using a score of ≥6, sensitivity was 97.7% (95% CI 95.4–99.0).

    AUSDRISK was externally validated (along with several other diabetes risk assessment models) in a cohort of 2,506 Dutch patients and found to have among the highest C-statistic of 12 basic models (i.e., those including noninvasive variables only) at 0.83 (95% CI 0.82–0.84) at 10 years (Abbasi 2012).

    Literature

    Dr. Lei Chen

    From the Creator

    Why did you develop the AUSDRISK tool? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
    Predicting risk for future type 2 diabetes is essential to identifying people who are suitable for diabetes prevention programs.

    What pearls, pitfalls and/or tips do you have for users of the AUSDRISK tool? Are there cases when it has been applied, interpreted, or used inappropriately?
    Like any risk score, it provides a broad indication of average risk for people with the parameters as entered. It was developed using data from Australia (with a predominantly white Anglo-Celtic population), and so absolute risk levels may vary in other populations.

    In your practice, how does the AUSDRISK tool help you counsel patients?
    It is straightforward, and gives a reasonable assessment of diabetes risk.

    In the paper, you mention that several different models were tested in terms of the measure of obesity: BMI, waist circumference, or both. Which model do you prefer, and why?
    I would recommend using the prediction model with waist circumference, but without BMI. In circumstances where waist circumference is not available, the model with BMI can be used instead. In the paper, we have described the reason why we chose to use waist circumference in detail. The prediction model with waist circumference only works well both in terms of discrimination and calibration. The model with the inclusion of both waist and BMI did not improve the calibration significantly (Box 2).

    About the Creator

    Lei Chen, MBBS, MMed, MD, PhD, is an endocrinologist and researcher. Her Ph.D is in epidemiology and she has over 15 years of experience in epidemiological and clinical studies in obesity, diabetes and co-morbidities.

    To view Dr. Lei Chen's publications, visit PubMed

    Content Contributors
    • Stuart McMaster, MBChB