Risk scores for type 2 diabetes mellitus in Latin America: a systematic review of population‐based studies

Abstract

Aim

To summarize the evidence on diabetes risk scores for Latin American populations.

Methods

A systematic review was conducted ( CRD42019122306) looking for diagnostic and prognostic models for type 2 diabetes mellitus among randomly selected adults in Latin America. Five databases ( LILACS, Scopus, MEDLINE, Embase and Global Health) were searched. type 2 diabetes mellitus was defined using at least one blood biomarker and the reports needed to include information on the development and/or validation of a multivariable regression model. Risk of bias was assessed using the PROBAST guidelines.

Results

Of the 1500 reports identified, 11 were studied in detail and five were included in the qualitative analysis. Two reports were from Mexico, two from Peru and one from Brazil. The number of diabetes cases varied from 48 to 207 in the derivations models, and between 29 and 582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was ~ 70% (range: 66–72%) as per the area under the receiving‐operator curve, the highest metric was always the negative predictive value. Sensitivity was always higher than specificity.

Conclusion

There is no evidence to support the use of one risk score throughout Latin America. The development, validation and implementation of risk scores should be a research and public health priority in Latin America to improve type 2 diabetes mellitus screening and prevention.

What's new?

• Risk scores are tools that could support screening, diagnosis and prognosis decisions in clinical medicine and public health.

• Risk scores for undiagnosed diabetes or to predict diabetes are available worldwide with a few in Latin America. However, the characteristics of risk scores available for Latin America, their performance, pitfalls and other attributes have not been summarized or appraised.

• A lack of synthesized information makes it difficult to understand the strengths and limitations of the available tools, hampering their implementation in clinical and screening guidelines.

• We conducted a thorough search for risk scores for type 2 diabetes developed in Latin America, providing the clinical and public health communities with evidence to inform their decisions regarding these risk scores.

• Local and regional health organizations could recommend one risk score or foster the development of a stronger tool to overcome the limitations signalled herein.