ORIGINAL ARTICLE Screening for Type 2 Diabetes and Dysglycemia in Saudi Arabia: Development and Validation of Risk Scores Ziad A. Memish, MD, 1 Jennifer L. Chang, MPH, MSN, 2 Mohammad Y. Saeedi, MD, 1 Mohammad A. Al Hamid, MD, 1 Omer Abid, MD, 1 and Mohammed K. Ali, MBChB, MSc, MBA 2 Abstract Objective: The prevalence of type 2 diabetes in Saudi Arabia is the highest worldwide after excluding small island nations. We developed and validated a noninvasive screening test based on demographic and clinical data for identifying adults with undiagnosed diabetes and dysglycemia in Saudi Arabia. Research Design and Methods: Data from 1,485 nonpregnant Saudi adults ‡20 years of age without a current diagnosis of diabetes were obtained from urban and rural primary healthcare centers in 2009. Clinical and demographic data were obtained through physician-administered interviews. Oral glucose tolerance test data were used to define diabetes (fasting plasma glucose ‡7.0 mmol/L or 2-h post-load glucose ‡11.1 mmol/L) and dysglycemia (fasting plasma glucose ‡5.6 mmol/L or 2-h post-load glucose ‡7.8 mmol/L). Predictive models were developed using data from 1,435 individuals. Multivariable logistic regression and receiver operating characteristic curves were used to develop and evaluate a separate risk score for both diabetes and dysglycemia. Scores were validated on a hold-out sample of 50 individuals. Results: The risk score for undiagnosed diabetes contained age, history of gestational diabetes, smoking, family history of diabetes, and central obesity with a sensitivity of 76.6% and a specificity of 52.1%. The dysglycemia risk score contained age, gestational diabetes, hypertension, and central obesity with a sensitivity of 71.2% and a specificity of 54.0%. All performed equally well, if not better, in the hold-out sample. Conclusions: These risk scores can identify Saudi adults with undiagnosed diabetes or dysglycemia and should be validated in prospective studies. Introduction D iabetes was estimated to affect 382 million adults (20–79 years of age) worldwide in 2013. 1 More than 90% of diabetes cases are type 2 diabetes mellitus, a pro- gressive disease that leads to organ dysfunction and, in particular, the emergence of retinopathy, neuropathy, and nephropathy. 2 Type 2 diabetes also increases the risk of stroke, heart disease, and all-cause mortality by 1.4–4.5 times. 3–5 After six small island nations, Saudi Arabia has the highest national diabetes prevalence (20.2%) world- wide, and this percentage is projected to increase to 27.1% by 2035. 1 From the literature, the prevalence of diabe- tes has been found to be approximately 23% in a cross- sectional citywide study to 24% in a large nationwide epidemiologic study. 6,7 Early glycemic control reduces the risk for micro- and long-term macrovascular complications and mortality in people with diabetes. 8,9 However, type 2 diabetes is an in- sidious disease, and a little fewer than half of those with diabetes worldwide remain unaware until symptoms or complications develop. 1,2 In the United States, 32% of adults with diabetes remain undiagnosed, and this proportion has been noted to be as high as 60.7% in developing countries like China. 10,11 Dysglycemia, the inadequate regulation of blood glucose levels, refers to both prediabetes (the precursor phase before diabetes) and type 2 diabetes. 2 People with prediabetes have an annual risk of developing diabetes that is five to 10 times higher than that of people with normal glu- cose levels and tolerance. 12 However, robust evidence has shown that lifestyle interventions can slow the progression from prediabetes to diabetes. Research trials show that 1 Ministry of Health, Riyadh, Kingdom of Saudi Arabia. 2 Emory University, Atlanta, Georgia, USA. DIABETES TECHNOLOGY & THERAPEUTICS Volume 17, Number 10, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/dia.2014.0267 693