Common tools used by clinicians to predict the risk of type 2 diabetes are consistently miscalibrated with respect to race, a long-term study has found. The issue raises the likelihood that certain racial groups are being over- or undertreated, researchers say.
Investigators from the University of Copenhagen in Denmark evaluated the Prediabetes Risk Test (PRT) issued by the National Diabetes Prevention Program, the Framingham Offspring Risk Score and the Atherosclerosis Risk in Communities (ARIC) model.
Data involving nearly 10,000 adults came from the National Health and Nutrition Examination Survey, sampled multiple times between 1999 and 2010. Participants had no prior diagnosis of diabetes and fasting blood samples were included. The researchers calculated predicted risks of type 2 diabetes according to the models and then compared those predictions with those observed using the U.S. Diabetes Surveillance System across racial groups.
All of the models were miscalibrated by race throughout the study period, reported Héléne T. Cronjé, PhD, and colleagues. The Framingham Offspring Risk Score, for example, overestimated type 2 diabetes risk for non-Hispanic whites and underestimated risk for non-Hispanic Blacks. Risk was overestimated for both races in the PRT and the ARIC models, but more so for non-Hispanic whites.
These incorrect calculations may result in more non-Hispanic whites being prioritized for preventive interventions, but it also increases their risk of overdiagnosis and overtreatment. Similarly “a larger proportion of non-Hispanic Blacks may be potentially underprioritized and undertreated,” the authors concluded.
The study was published in PLOS Global Public Health.
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