Limited Effectiveness of Diabetes Risk Assessment Tools in Seniors’ Facility Residents

Abstract

Background Undiagnosed diabetes can create significant management issues for seniors. Objectives To evaluate the effectiveness of two diabetes risk surveys—the Canadian Diabetes Risk Assessment Questionnaire (CANRISK) and the Finnish Diabetes Risk Score (FINDRISC)—to identify elevated blood glucose levels in seniors. Methods A cross-sectional study was conducted in senior living facilities in Edmonton, Alberta, Canada. Those with known diabetes, without capacity, considered frail, or unable to communicate in English were excluded. Participants completed the CANRISK and FINDRISC surveys and had their glycated hemoglobin A1c (HbA1c) measured. Correlations between seniors with elevated risk on the surveys and an HbA1c value of 6.5% or higher or 6.0% and higher were assessed. Results In this study, 290 residents participated; their mean age was 84.3 ± 7.3 years, 82 (28%) were men, and their mean HbA1c level was 5.7% ± 0.4%. Mean CANRISK score was 29.4 ± 8.0, and of the 254 (88%) considered to be moderate or high risk, 10 (4%) had an HbA1c level of 6.5% or higher and 49 (19%) had an HbA1c level of 6.0% or higher. Mean FINDRISC score was 10.8 ± 4.2, and of the 58 (20%) considered to be high or very high risk, 4 (7%) had an HbA1c level of 6.5% or higher and 15 (26%) had an HbA1c level of 6.0% or higher. The area under the receiver-operating characteristic curve was 0.57 (95% confidence interval 0.42–0.72) for the CANRISK survey identifying participants with an HbA1c level of 6.5% or higher and 0.59 (95% confidence interval 0.51–0.67) for identifying participants with an HbA1c level of 6.0% or higher. Similar characteristics were observed for the FINDRISC survey. Conclusions In this group of seniors with no known diabetes history, mean HbA1c level approximated that in the general population and neither survey effectively identified those with elevated blood glucose levels. These findings should be confirmed in a larger study; nevertheless, routine use of these surveys as a diabetes screening strategy does not appear to be warranted at this time.