Survey of diabetes risk assessment tools: concepts, structure and performance Thitaporn Thoopputra 1 David Newby 2 Jennifer Schneider 1 Shu Chuen Li 1 * 1 Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia 2 Discipline of Clinical Pharmacology, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia *Correspondence to: Shu Chuen Li, Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia. E-mail: Shuchuen.li@newcastle. edu.au Summary The objective of this study is to review the effectiveness and limitations of existing diabetes risk screening tools to assess the need for further developing of such tools. An electronic search of the EMBASE, MEDLINE, and Cochrane library supplemented by a manual search was performed from 1995–2010. The search retrieved a total of 2168 articles reporting diabetes risk assessment tools which, after culling, produced 41 tools developed in 22 countries, with the majority (n = 26) developed in North America and Europe. All are short questionnaires of 2–16 questions incorporating common variables including age, gender, waist circumference, BMI, family history of diabetes, history of hypertension or antihypertensive medications. While scoring format and cut-offs point are diverse between questionnaires, overall accuracy value range of 40-97%, 24-86% and 62-87% were reported for sensitivity, specificity and receiver operating characteristic curve respectively. In summary, there is a trend of increasing availability of diabetes prediction tools with the existing risk assessment tools being generally a short questionnaire aiming for ease of use in clinical practice. The overall performance of existing tools showed moderate to high accuracy in their predictive performance. However, further detailed comparison of existing questionnaires is needed to evaluate whether they can serve adequately as diabetes risk assessment tool in clinical practice. Copyright © 2012 John Wiley & Sons, Ltd. Keywords diabetes; risk assessment; screening Introduction Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. The disease can be classified into 2 types – type 1 diabetes where insulin is required for survival and type 2 diabetes, which is a condition related to disorder of insulin secretion or insulin sensitivity [1]. It is well known that the prevalence of diabetes has increased significantly in recent years, and it is estimated that over 400 million will suffer from diabetes mellitus by 2030 worldwide [2]. Patients with type 2 diabetes will comprise a large proportion of this accelerating prevalence globally, and more alarmingly, there is a downward trend in the age of the patients. Furthermore, diabetes is often asymptomatic at its early stage and can remain undiagnosed for several years, and many patients are diagnosed only after symptoms of complications appear. In fact, diabetes complications are a major contributor to morbidity and reduced life expectancy. Adults with diabetes have been shown to have higher rates of stroke and death from heart disease [3]. With the increasing prevalence of diabetes, the number of end-stage renal disease caused by dia- betic nephropathy has also increased. In China, the prevalence of diabetes with REVIEW ARTICLE Received: 4 October 2011 Revised: 19 January 2012 Accepted: 23 February 2012 Copyright © 2012 John Wiley & Sons, Ltd. DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2012; 28: 485–498. Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/dmrr.2296