The aim of this study is to predict the risk of developing type 2 diabetes mellitus in a young adult population in Nigeria using the validated FINDRISC tool. This is necessary as the identification of individuals at risk will enable such individuals to begin to adopt a series of necessary lifestyle changes within the shortest time frame.
In predicting type 2 diabetes, the validated FINDRISC tool scores eight components: age, body mass index (BMI), waist circumference, physical activity, consumption of vegetables, fruits and berries, use of antihypertensives, previous diagnosis of high blood glucose and family history of diabetes.
Participants
A population-based cohort study was carried out to assess the risk of developing type 2 diabetes mellitus among young adults (aged 15–35 years) in Asaba, Delta State, Nigeria, using the validated Finnish Diabetes Risk Score (FINDRISC) tool.
Informed consent and Ethics Committee approval
An informed consent form designed in accordance with the guidelines of the research ethics review committee of World Health Organization was distributed to the participants. Only participants who filled the informed consent form thereby indicating their willingness to freely participate in the study took part in the study. Ethical clearance was obtained from the Delta State Ministry of Health Research Ethics Committee, Asaba, Nigeria (HM/596/T/55). Male and female participants were selected by convenience sampling without any form of prejudice. Participants were not coerced into participation, and they were duly informed that they reserved the right to opt out of the study without facing any consequences of any kind.
Exclusion criteria
The conditions for exclusion of a participant from the study are as follows: a prior diagnosis of diabetes, a fasting blood glucose of ≥ 126 mg/dL, use of prescribed drugs or diets for diabetes control and management as well as a decline of consent.
Sample size
The sample size was determined using the Vaughan’s formula (Vaughan and Morrow 1989) as reported by Agu et al. (2015)
$$N = \frac{PQ}{{\left( {{\raise0.7ex\hbox{$E$} \!\mathord{\left/ {\vphantom {E {1.96}}}\right.\kern-\nulldelimiterspace} \!\lower0.7ex\hbox{${1.96}$}}} \right)^{2} }}$$
N is sample size; P is maximum expected prevalence rate of diabetes mellitus; Q is \(100 - P\); E is margin of sample error tolerated in percentage (5% being the maximum accepted value).
Considering a 4.5% error margin and a diabetes prevalence rate of 5.4% in Delta State, Nigeria, (Oguoma et al. 2015; Adeloye et al. 2017) a minimum sample size of 97 participants was recommended for the study. However, in order to make adequate provisions for errors in filling of questionnaires due to inconsistency and possible data losses, a total sample size of 140 was adopted.
Blood glucose measurement
The fasting blood sugar of participants was determined by thumb-pricking using a sterilized lancet. A drop of blood was tested on the glucose test strip using a standard glucometer (Accu-Chek Active, Roche Mannheim, Germany).
The FINDRISC tool
The FINDRISC tool, designed by Lindström and Tuomilehto in 2003, is a widely used tool for predicting the risk of developing diabetes mellitus. In this tool, eight variable components that are linked with anthropometric and lifestyle patterns are scored. These components include age, BMI, waist circumference, physical activity, consumption of vegetables, fruits or berries, blood pressure medication, previous diagnosis of high blood sugar and family history of diabetes.
(a) Anthropometric measurements The participants’ weight was measured in kilograms, to the nearest 0.1Kg using a standard weighing scale (Hana model, China) while ensuring that the participant was wearing light clothing and he or she wore no shoes. A stadiometer was used to measure participants’ height to the nearest 0.1 cm. Participants’ body mass index (BMI) was calculated using the formula:
$${\text{BMI}} = \frac{{{\text{Weight}}\; \left( {{\text{kg}}} \right)}}{{{\text{Height}}^{2} \;({\text{m}}^{2} )}}$$
Waist circumference was measured with the participant in an erect posture. Similarly, participants’ hip circumference was measured. This was used to calculate the participant’s waist-to-hip ratio.
(b) Risk score calculation The variable components of the validated FINDRISC tool were scored to determine a participants’ diabetes risk score. The age component was scored as follows: under 45 years scored 0 point; 45–54 years scored 2 points; 55–64 years scored 3 points; and over 64 years scored 4 points. The BMI component was scored as follows: < 25 kg/m2 scored 0 point; 25–30 kg/m2 scored 1 point; > 30 kg/m2 scored 3 points. The waist circumference component was scored as follows: < 94 cm for men or < 80 cm scored 0 point; 94–102 cm for men or 80–88 cm for women scored 3 points; and > 102 cm for men or > 88 cm for women scored 4 points. The physical activity component was scored as follows: a physical activity of at least 30 min on a daily basis scored 0 point; if less, it scored 2 points. The consumption of vegetables, fruits or berries component was scored as follows: a daily consumption of vegetables, fruits or berries scored 0 point; if not every day, it scored 1 point. The use of antihypertensive component was scored as follows: a regular use of antihypertensive was scored 2 points; if not, it scored 0 point. The previous diagnosis of high blood glucose component was scored as follows: a previous diagnosis of high blood glucose in the past (either in a health examination, illness or pregnancy) scored 5 points; if not, it scored 0 point. The family history of diabetes component was scored as follows: a parent, brother, sister or own child having been diagnosed of diabetes scored 5 points; a grandparent, aunt, uncle or first cousin having been diagnosed of diabetes scored 3 points; if none of these immediate family or relatives have been diagnosed, it scored 0 point.
At the end of the risk scoring process, every participant was informed of his/her score and appropriate health education was offered as part of benefits of participation in this study. In particular, high scoring participants were strongly advised on the need for regular blood sugar testing. The participants’ total risk score was summed up from the respective scores of the different components followed by analysis and comparison. The total risk score was classified as follows: < 7 (low risk—an estimated 1 in 100 will develop disease); 7–11 (slightly elevated risk—an estimated 1 in 25 will develop disease); 12–14 (moderate risk—an estimated 1 in 6 will develop disease); 15–20 (high risk—an estimated 1 in 3 will develop disease); > 20 (very high risk—an estimated 1 in 2 will develop disease).
Statistical analysis
Data were analyzed on the basis of sex and age group and where appropriate, data were reported as mean ± standard deviations. The prevalence of the risk profile was determined as a ratio of the number of participants presenting with the particular risk category and the total number of participants multiplied by 100. Descriptive data analysis was done using Statistical Package for the Social Sciences (SPSS) version 23.0 (SPSS Inc Chicago IL), while charts were generated with Microsoft Excel 2003 (Microsoft Corporation US).