Derivation and external validation of a simple prediction model for the diagnosis of type 2 Diabetes Mellitus in the Brazilian urban population

  • André Gustavo Pires de Sousa
  • Alexandre Costa Pereira
  • Guilherme Figueiredo Marquezine
  • Raimundo Marques do Nascimento-Neto
  • Silvia N. Freitas
  • Roney Luiz de C. Nicolato
  • George Luiz Lins Machado-Coelho
  • Sérgio L. Rodrigues
  • José G. Mill
  • José Eduardo Krieger


A risk score model was developed based in a population of 1,224 individuals from the general population without known diabetes aging 35 years or more from an urban Brazilian population sample in order to select individuals who should be screened in subsequent testing and improve the efficacy of public health assurance. External validation was performed in a second, independent, population from a different city ascertained through a similar epidemiological protocol. The risk score was developed by multiple logistic regression and model performance and cutoff values were derived from a receiver operating characteristic curve. Model’s capacity of predicting fasting blood glucose levels was tested analyzing data from a 5-year follow-up protocol conducted in the general population. Items independently and significantly associated with diabetes were age, BMI and known hypertension. Sensitivity, specificity and proportion of further testing necessary for the best cutoff value were 75.9, 66.9 and 37.2%, respectively. External validation confirmed the model’s adequacy (AUC equal to 0.72). Finally, model score was also capable of predicting fasting blood glucose progression in non-diabetic individuals in a 5-year follow-up period. In conclusion, this simple diabetes risk score was able to identify individuals with an increased likelihood of having diabetes and it can be used to stratify subpopulations in which performing of subsequent tests is necessary and probably cost-effective.


Type 2 diabetes Diabetes prediction model Risk score Diabetes Mellitus 



American Diabetes Association


Area under curve


Body mass index


Cardiovascular diseases


Diastolic blood pressure


Events per variable


Fasting plasma glucose


High density lipoprotein cholesterol


Impaired fasting glycemia


Impaired glucose tolerance


Low density lipoprotein cholesterol


Oral glucose tolerance test


Polycystic ovarian syndrome

ROC curve

Receiver operating characteristic curve


Systolic blood pressure


Type 2 Diabetes Mellitus



This work was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo [grant number 07/54138-2]


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • André Gustavo Pires de Sousa
    • 1
    • 2
  • Alexandre Costa Pereira
    • 1
  • Guilherme Figueiredo Marquezine
    • 1
  • Raimundo Marques do Nascimento-Neto
    • 3
    • 4
  • Silvia N. Freitas
    • 5
  • Roney Luiz de C. Nicolato
    • 5
  • George Luiz Lins Machado-Coelho
    • 5
  • Sérgio L. Rodrigues
    • 6
  • José G. Mill
    • 6
  • José Eduardo Krieger
    • 1
  1. 1.Laboratory of Genetics and Molecular Cardiology, Heart InstituteUniversity of São Paulo Medical SchoolSão Paulo-SPBrazil
  2. 2.Clinical Medicine DepartmentFederal University of Rio Grande do NorteNatalBrazil
  3. 3.Arterial Hypertension InstituteBelo HorizonteBrazil
  4. 4.Federal University of Ouro Preto Medical SchoolOuro PretoBrazil
  5. 5.Pharmacy DepartmentFederal University of Ouro PretoOuro PretoBrazil
  6. 6.Department of Physiological SciencesFederal University of Espirito SantoVitoriaBrazil

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