{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:20:30Z","timestamp":1789802430411,"version":"4.0.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The application of risk scores has often effectively predicted undiagnosed type 2 diabetes in a non-invasive way to guide early clinical management. The capacity for diagnosing diabetes in developing countries including Kenya is limited. Screening tools to identify those at risk and thus target the use of limited resources could be helpful, but these are not validated for use in these settings. We, therefore, aimed to measure the performance of the Finnish diabetes risk score (FINDRISC) as a screening tool to detect undiagnosed diabetes among Kenyan adults.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A nationwide cross-sectional survey on non-communicable disease risk factors was conducted among Kenyan adults between April and June 2015. Diabetes mellitus was defined as fasting capillary whole blood \u2265 7.0mmol\/l. The performance of the original, modified, and simplified FINDRISC tools in predicting undiagnosed diabetes was assessed using the area under the receiver operating curve (AU-ROC). Non-parametric analyses of the AU-ROC, Sensitivity (Se), and Specificity (Sp) of FINDRISC tools were determined.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 4,027 data observations of individuals aged 18\u221269 years were analyzed. The proportion\/prevalence of undiagnosed diabetes and prediabetes was 1.8% [1.3\u20132.6], and 2.6% [1.9\u20133.4] respectively. The AU-ROC of the modified FINDRISC and simplified FINDRISC in detecting undiagnosed diabetes were 0.7481 and 0.7486 respectively, with no statistically significant difference (p = 0.912). With an optimal cut-off \u2265 7, the simplified FINDRISC had a higher positive predictive value (PPV) (7.9%) and diagnostic odds (OR:6.65, 95%CI: 4.43\u20139.96) of detecting undiagnosed diabetes than the modified FINDRISC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The simple, non-invasive modified, and simplified FINDRISC tools performed well in detecting undiagnosed diabetes and may be useful in the Kenyan population and other similar population settings. For resource-constrained settings like the Kenyan settings, the simplified FINDRISC is preferred.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0276858","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T17:29:02Z","timestamp":1682530142000},"page":"e0276858","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18\u201369 years"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7006-4718","authenticated-orcid":true,"given":"Innocent B.","family":"Mugume","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-015X","authenticated-orcid":true,"given":"Solomon T.","family":"Wafula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damazo T.","family":"Kadengye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9724-1887","authenticated-orcid":true,"given":"Josefien","family":"Van Olmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"pone.0276858.ref001","unstructured":"World Health Organization. Diagnosis and management of type 2 diabetes (HEARTS-D. WHO\/UCN\/NCD\/20.1. 2020: Geneva"},{"key":"pone.0276858.ref002","unstructured":"World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO\/IDF consultation. 2006: Geneva."},{"key":"pone.0276858.ref003","unstructured":"World Health Organization. Non-communicable diseases country profiles 2018. Geneva; 2018 (https:\/\/www.who.int\/nmh\/publications\/ncd-profiles-2018\/en\/pdf). 2018."},{"key":"pone.0276858.ref004","unstructured":"International Diabetes Federation. IDF Diabetes Atlas 2019. (http:\/\/www.idf.org\/diabetesatlas). 2019."},{"issue":"4","key":"pone.0276858.ref005","doi-asserted-by":"crossref","first-page":"546","DOI":"10.4103\/2230-8210.183480","article-title":"Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum?","volume":"20","author":"A. Chawla","year":"2016","journal-title":"Indian Journal of Endocrinology and Metabolism"},{"issue":"3","key":"pone.0276858.ref006","first-page":"60","article-title":"Diabetes Mellitus: the increasing burden of disease in Kenya","volume":"6","author":"T., L.E Jones","year":"2013","journal-title":"South Sudan Medical Journal"},{"issue":"2","key":"pone.0276858.ref007","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.diabres.2013.11.001","article-title":"Global estimates of undiagnosed diabetes in adults","volume":"103","author":"J. Beagley","year":"2014","journal-title":"Diabetes Res Clin Pract"},{"issue":"Suppl 3","key":"pone.0276858.ref008","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1186\/s12889-018-6053-x","article-title":"Prevalence and factors associated with pre-diabetes and diabetes mellitus in Kenya: results from a national survey","volume":"18","author":"S.F. Mohamed","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0276858.ref009","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/3086167","article-title":"Complications of diabetes 2017","volume":"2018","author":"K. Papatheodorou","year":"2018","journal-title":"Journal of Diabetes Research"},{"issue":"3","key":"pone.0276858.ref010","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.amjmed.2009.12.004","article-title":"Glycemic control and complications in type 2 diabetes mellitus","volume":"123","author":"M. Stolar","year":"2010","journal-title":"The American Journal of Medicine"},{"issue":"3","key":"pone.0276858.ref011","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.diabres.2014.06.007","article-title":"Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes","volume":"105","author":"J. Smith-Palmer","year":"2014","journal-title":"Diabetes Research and Clinical practice"},{"issue":"2","key":"pone.0276858.ref012","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11892-019-1124-7","article-title":"Economic Impact of Diabetes in Africa","volume":"19","author":"C. Mapa-Tassou","year":"2019","journal-title":"Current Diabetes Reports"},{"key":"pone.0276858.ref013","unstructured":"Abegunde, D. and A. Stanciole, An estimation of the economic impact of chronic noncommunicable diseases in selected countries. 2006, World Health Organization, Department of Chronic Diseases and Health Promotion."},{"issue":"9702","key":"pone.0276858.ref014","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/S0140-6736(09)61457-4","article-title":"10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study","volume":"374","author":"W.C. Knowler","year":"2009","journal-title":"Lancet"},{"key":"pone.0276858.ref015","unstructured":"WHO, Preventing chronic diseases: a vital investment:. 2005, World Health Organization: Geneva."},{"key":"pone.0276858.ref016","unstructured":"WHO, Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings. 2011, World Health Organization: Geneva."},{"issue":"9","key":"pone.0276858.ref017","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.2337\/diacare.27.9.2120","article-title":"Cost-effectiveness analysis of different screening procedures for type 2 diabetes: the KORA Survey 2000","volume":"27","author":"A. Icks","year":"2004","journal-title":"Diabetes Care"},{"issue":"Suppl 1","key":"pone.0276858.ref018","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.2337\/diacare.27.2007.S11","article-title":"Screening for type 2 diabetes","volume":"27","author":"American Diabetes, A","year":"2004","journal-title":"Diabetes Care"},{"key":"pone.0276858.ref019","article-title":"Readiness of sub-Saharan Africa healthcare systems for the new pandemic, diabetes: a systematic review","volume":"2018","author":"B. Nuche-Berenguer","year":"2018","journal-title":"Journal of Diabetes Research"},{"issue":"5","key":"pone.0276858.ref020","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.2337\/dc07-1150","article-title":"Diabetes Risk Calculator: a simple tool for detecting undiagnosed diabetes and pre-diabetes","volume":"31","author":"K.E. Heikes","year":"2008","journal-title":"Diabetes Care"},{"key":"pone.0276858.ref021","doi-asserted-by":"crossref","first-page":"b880","DOI":"10.1136\/bmj.b880","article-title":"Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore","volume":"338","author":"J. Hippisley-Cox","year":"2009","journal-title":"Bmj"},{"issue":"3","key":"pone.0276858.ref022","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2337\/diacare.26.3.725","article-title":"The diabetes risk score: a practical tool to predict type 2 diabetes risk","volume":"26","author":"J. Lindstrom","year":"2003","journal-title":"Diabetes Care"},{"key":"pone.0276858.ref023","first-page":"755","article-title":"Indian Diabetes Risk Score","volume":"53","author":"S.R. Joshi","year":"2005","journal-title":"J Assoc Physicians India"},{"issue":"3","key":"pone.0276858.ref024","doi-asserted-by":"crossref","first-page":"e33437","DOI":"10.1371\/journal.pone.0033437","article-title":"A risk score to predict type 2 diabetes mellitus in an elderly Spanish Mediterranean population at high cardiovascular risk","volume":"7","author":"M. Guasch-Ferre","year":"2012","journal-title":"PLoS One"},{"issue":"1","key":"pone.0276858.ref025","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1464-5491.2011.03376.x","article-title":"Two risk score models for predicting incident Type 2 diabetes in Japan","volume":"29","author":"Y. Doi","year":"2012","journal-title":"Diabetic Medicine"},{"issue":"2","key":"pone.0276858.ref026","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3132\/dvdr.2005.011","article-title":"Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome","volume":"2","author":"T. Saaristo","year":"2005","journal-title":"Diabetes and Vascular Disease Research"},{"key":"pone.0276858.ref027","article-title":"Optimal Threshold of the Finnish Diabetes Risk Score (Findrisc) for Screening at-Risk Adults in an African Population in Southern Benin","author":"C. Metonnou-Adanhoume","year":"2019","journal-title":"Universal Journal of Public Health"},{"issue":"4","key":"pone.0276858.ref028","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.pcd.2013.07.004","article-title":"The performance of the Finnish Diabetes Risk Score, a modified Finnish Diabetes Risk Score and a simplified Finnish Diabetes Risk Score in community-based cross-sectional screening of undiagnosed type 2 diabetes in the Philippines","volume":"7","author":"G.M. Ku","year":"2013","journal-title":"Prim Care Diabetes"},{"key":"pone.0276858.ref029","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.proeng.2015.06.096","article-title":"Pathways and Barriers to Diabetes Screening: Observations from Rural Kenya","volume":"107","author":"E. Browna","year":"2015","journal-title":"Procedia Engineering"},{"issue":"11","key":"pone.0276858.ref030","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S2213-8587(16)30181-4","article-title":"Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries","volume":"4","author":"J. Manne-Goehler","year":"2016","journal-title":"The lancet Diabetes Endocrinology"},{"key":"pone.0276858.ref031","unstructured":"Ministry of Health, Kenyan National Bureau of Statistics, and WHO, Kenya STEPwise Survey for Non-Communicable Diseases Risk Factors 2015 Report. 2015."},{"key":"pone.0276858.ref032","unstructured":"WHO. Global physical activity questionnaire (GPAQ) analysis guide. 2012; http:\/\/www.who.int\/chp\/steps\/resources\/GPAQ_Analysis_Guide.pdf."},{"key":"pone.0276858.ref033","first-page":"9","article-title":"1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension","volume":"8","author":"M. Alderman","year":"1999","journal-title":"Journal of Hypertension"},{"issue":"1","key":"pone.0276858.ref034","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S2213-8587(15)00362-9","article-title":"Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study","volume":"4","author":"S. Ligthart","year":"2016","journal-title":"The lancet Diabetes Endocrinology"},{"issue":"Suppl 1","key":"pone.0276858.ref035","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.2337\/dc11-S062","article-title":"Diagnosis and classification of diabetes mellitus","volume":"34 Suppl 1","author":"American Diabetes Association","year":"2011","journal-title":"Diabetes care"},{"key":"pone.0276858.ref036","unstructured":"National Institute of Health. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. 2000; https:\/\/www.nhlbi.nih.gov\/files\/docs\/guidelines\/prctgd_c.pdf."},{"key":"pone.0276858.ref037","unstructured":"WHO, Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8\u201311 December 2008. 2011, World Health Organization: Geneva."},{"issue":"7","key":"pone.0276858.ref038","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1093\/aje\/kwj063","article-title":"The inconsistency of \u201coptimal\u201d cutpoints obtained using two criteria based on the receiver operating characteristic curve","volume":"163","author":"N.J. Perkins","year":"2006","journal-title":"American Journal of Epidemiology"},{"key":"pone.0276858.ref039","unstructured":"World Health Organization. NCD Microdata Repository. (https:\/\/extranet.who.int\/ncdsmicrodata\/index.php\/home). 2019."},{"issue":"10","key":"pone.0276858.ref040","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"E. von Elm","year":"2007","journal-title":"PLoS Med"},{"issue":"2","key":"pone.0276858.ref041","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.diabet.2010.09.006","article-title":"Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece","volume":"37","author":"K. Makrilakis","year":"2011","journal-title":"Diabetes and Metabolism"},{"issue":"1","key":"pone.0276858.ref042","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.diabres.2010.12.020","article-title":"Evaluation of the Finnish Diabetes Risk Score as a screening tool for impaired fasting glucose, impaired glucose tolerance and undetected diabetes","volume":"92","author":"T. Tankova","year":"2011","journal-title":"Diabetes Res Clin Pract"},{"issue":"9","key":"pone.0276858.ref043","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.medcli.2011.05.025","article-title":"Validation of the FINDRISC (FINnish Diabetes RIsk SCore) for prediction of the risk of type 2 diabetes in a population of southern Spain. Pizarra Study","volume":"138","author":"F. Soriguer","year":"2012","journal-title":"Medicina clinica"},{"issue":"5","key":"pone.0276858.ref044","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.pcd.2015.04.004","article-title":"Application and applicability of non-invasive risk models for predicting undiagnosed prevalent diabetes in Africa: A systematic literature search","volume":"9","author":"V. Mbanya","year":"2015","journal-title":"Prim Care Diabetes"},{"issue":"1","key":"pone.0276858.ref045","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1741-7015-11-45","article-title":"Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy","volume":"11","author":"B. Costa","year":"2013","journal-title":"BMC Medicine"},{"issue":"5","key":"pone.0276858.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0097865","article-title":"Evaluation of Finnish Diabetes Risk Score in screening undiagnosed diabetes and prediabetes among US adults by gender and race: NHANES 1999\u20132010","volume":"9","author":"L. Zhang","year":"2014","journal-title":"PloS one"},{"key":"pone.0276858.ref047","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13098-015-0039-y","article-title":"Independent external validation and comparison of prevalent diabetes risk prediction models in a mixed-ancestry population of South Africa","volume":"7","author":"K. Masconi","year":"2015","journal-title":"Diabetol Metab Syndr"},{"key":"pone.0276858.ref048","doi-asserted-by":"crossref","first-page":"4968350","DOI":"10.1155\/2016\/4968350","article-title":"Validity of the Finnish Diabetes Risk Score for Detecting Undiagnosed Type 2 Diabetes among General Medical Outpatients in Botswana","volume":"2016","author":"B. Omech","year":"2016","journal-title":"Journal of diabetes research"},{"issue":"5","key":"pone.0276858.ref049","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/S1957-2557(14)70877-6","article-title":"Apport du score de risque finlandais FINDRISC dans l\u2019identification de la dysglyc\u00e9mie dans une population alg\u00e9roise, Alg\u00e9rie","volume":"8","author":"M. Azzouz","year":"2014","journal-title":"M\u00e9decine des Maladies M\u00e9taboliques"},{"issue":"1","key":"pone.0276858.ref050","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"J.A. Hanley","year":"1982","journal-title":"Radiology"},{"issue":"2","key":"pone.0276858.ref051","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2337\/diacare.23.2.187","article-title":"Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population","volume":"23","author":"C.L. Rohlfing","year":"2000","journal-title":"Diabetes Care"},{"issue":"4","key":"pone.0276858.ref052","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/j.1464-5491.2007.02106.x","article-title":"HbA1c as a screening tool for detection of Type 2 diabetes: a systematic review","volume":"24","author":"C.M. Bennett","year":"2007","journal-title":"Diabetic Medicine"},{"issue":"2","key":"pone.0276858.ref053","first-page":"103","article-title":"Diabetes Mellitus: Screening and Diagnosis","volume":"93","author":"K. Pippitt","year":"2016","journal-title":"Am Fam Physician"},{"key":"pone.0276858.ref054","unstructured":"World Health Organization. Screening for type 2 diabetes. 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