الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
T2DM is a chronic debilitating widely expanding illness with serious micro- and macro-vascular complications that impose huge burden on the development and health expenditure. Its development, progression and management are highly influenced by a set of biological and behavioral risk factors entailing the age, sex, family history, overweight/ obesity, smoking, hypertension, physical inactivity, unhealthy diet, and alcohol intake. Screening for DM relied for long time on invasive, inconvenient, and expensive laboratory techniques. Emergence of simple, noninvasive, and sensitive T2DM risk score screening tools produced a big detente in the prevention of the NCDs in general and T2DM in particular. Many tools have been developed, tested, and proved to be sensitive to identify undiagnosed T2DM, and PDM, and predict the probability of T2DM occurrence in the forthcoming 5-10 years.
The aim of this study was to conduct a community-based screening for T2DM using the AUSDRISK in Beheira governorate, to identify cases with undiagnosed DM and PDM, assess the risk of T2DM, and identify the associated risk factors.
Recalibration (translation and back translation) was processed according to the WHO procedures. An Arabic version was produced and proved to be valid and reliable in a pilot study of 10 villagers. Using the WHO cluster sample, a sum of 18+ years 719 residents living in 30 (20 rural + 10 urban) clusters from Damanhur district selected by SRS among Beheira 15 districts. Through household interview, each participant filled a pre-designed structured questionnaire comprising demographic, habitual, medical history, and physical data; vital body measurements; and the AUSDRISK Arabic version to calculate his/ her risk score. Each participant underwent FBG and OGTT.
The collected data were coded, revised, cleaned, tabulated, and analyzed through IBM SPSS-26 using the simple percentage, Chi square, ANOVA, AUC, reliability, sensitivity, specificity, positive predictive value, negative predictive value statistical tests.
Analyses of the study results revealed the followings:
1- Most of the participants were married (77.1%), females (69.3%), natively from Lower Egypt (97.5%), with averaged age (39.36 ± 14.77). While 40.1% and 25.6% of them completed their middle and higher educations, 22.7% and 5.1% were illiterate and only write and read.
2- Among the participants, 60.5% were physically active (5+ days/week), 70% reported indoor feeding and daily fruits/ vegetables intake, and 81.4% took high fat content food. 77.9%, 69.5%, 49.9%, and 20% of the participants respectively consumed animal fat, white meat, red meat, salty foods 2-3 times a week.
3- The medical history yielded that 40.3%, 12.4%, and 7.2% of the participants had family history of DM, history of hypertension, and previous history of hyperglycemia, respectively.
4- Meanwhile, only 11.7% of the participants were smoker, yet none of them was either alcoholic or drug user (0%).
5- On examination, ≈80% of the participants were overweight/ obese with averaged BMI and WC of 29.27 ± 5.5 kg/m2 and 95.42 ± 12.8 cm, respectively.
6- The average glycemic level of the participants was 92.02 ± 20.43 mg/dl for FPG and 121.54 ± 37.18 mg/dl for OGTT.
7- The percentage of the participants with normoglycemia, PDM dysglycemia, and undiagnosed DM hyperglycemia were 73.3%, 21.7%, & 5% and 70.9%, 24.1% & 5% according to the WHO and the ADA diagnostic criteria, respectively.
8- The overall AUSDRISK Arabic version averaged score of was 9.57 ± 6.06.
9- The 9-item AUSDRISK Arabic version score total score had a score range between 0 and 31 points. The risk categorization of the score was as follows: mild (<4), moderate (5-10), and severe (>11) risk. Its overall score cut off was 13
10- Based on modified AUSDRISK Arabic version score categories, 21.5%. 39.4%, and 39.1% of the participants were classified as at low (<4 points), moderate (5-10 points), and high (>11 points), risk, respectively.
11- There was significant increment in the mean age of DM participants (53.69 ± 14.91 years) compared to those with PDM (45.27 ± 14.55 years) and euglycemia (36.64 ± 13.73 years), (F= 42.916, P<0.01).
12- As regards the age predominance of the participant glycemic categories, there were significant predominance of the euglycemia in the youngest age groups <35 years (85.5%) and 35-<45 years (76.3%), almost equal distribution of the PDM between age groups 45-<55 years (35.9%), 55-<65 years (30.9%), and >65 years (36%), almost double DM prevalence in age group >65 years (20%) compared to that in the age group 45-<55 years (10.7%), (X2 = 87.201, P< 0.01).
13- The frequency of DM glycemia was higher among males (5.4%) than females (4.8%) with no significant difference in-between, (p>0.05).
14- There was statistically significant inverse association between the level of education and the DM frequency. The frequency of DM with illiteracy/ just read and write (7.5%) and basic education (8.5%) was > double that with middle (3.5%) and higher (3.8%) education, (X2= 21.522, P< 0.01)
15- The frequency of both DM and PDM among physically inactive participants (7.4%, 30.6%) was as twice as that of the physically inactive ones (3.4%, 15.9%), (X2= 30.837, P<0.01)
16- Higher frequency of DM among the participants who did not report vegetables and fruits intake on daily basis (6.5%) than those who did (4.4%), (X2= 3.273, P= 0.195).
17- There was significant higher DM prevalence among participants who responded positively to the history of hypertension (13.5%), previous history of high glucose level (55.8%), and family history of DM (7.2%) than those who responded negatively (3.8%, 1%, & 3.5%), (X2 respectively = 33.539, 320.771, & 14.568, P<0.01).
18- The overall averaged waist circumference was statistically highest in DM participants (105.75 ± 12.84 cm), modest with PDM participants (100.39 ± 12.77 cm), and lowest with the euglycemic ones (93.25 ± 12.11 cm). (F= 33.677, P<0.01)
19- Similarly, the BMI was significantly highest among the DM participants (33.74 ± 7.52 kg/m2), followed by that of the PDM participants (31.21 ± 5.85 kg/m2), and lowest among the euglycemic ones (28.4 ± 4.97 kg/m2). (F= 30.144, P<0.01).
20- The mean SBP and DBP levels were markedly highest with the DM hyperglycemia (128.33 ± 16.95 & 82.92 ± 13.17 mm Hg), modest with PDM dysglycemia (123.65 ± 14.28 & 79.8 ± 9.4 mm Hg) and lowest with the euglycemia (117.9 ±12.98 & 76.16± 9.17 mm Hg). The differences between the mean systolic and diastolic blood pressure were significantly different, (F= 18.749 for SBP & 15.686 for DBP; p< 0.01).
21- None of the gender, residency, and crowding index, was capable enough to exert either significant association with the glycemic status, (P > 0.05)
22- The history of hypercholesterolemia, history of hypertriglyceridemia, and heart rate failed to differ significantly between the DM hyperglycemia, PDM dysglycemia, and the euglycemia, p >0.05.
23- Parallel association between the AUSDRISK score and the glycemic status. The percentage of DM and PDM were highest with AUSDRISK score ≥11 (11.4%, 35.6%), followed by score 5-10 (1.4%, 15.2%) and score ≤4 (0.00%, 8.4%); (X2 = 107.854 (P<0.01). Likewise, the averaged AUSDRISK Arabic version score was highest with DM hyperglycemia (19.78 ±6.44), modest with PDM dysglycemia (12.59 ± 5.53), and lowest with euglycemia (7.98 ± 5.09), with significant differences in-between, (F= 117.419, P<0.01).
24- High AUSDRISK Arabic version score (>11) significantly associated with the urban residency (41.7%), (X2= 10.525, p<0.01), history of hypercholesterolemia (100%), and history of hypertriglyceridemia (95.5%), (X2= 33.718 & 30.334, p<0.01). Parallel relationship between the AUSDRISK risk category and the average of each of the BMI, FPG, and OGTT was evident. The higher the AUSDRISK category [low(L), moderate(M), & severe(S)] the rising the average of the BMI (L: 25.08 ± 3.19, M: 28.2 ± 4.65, & S: 32.57 ± 5.44 kg/m2; F= 136.004 , p<0.01); FPG (L: 82.92 ± 9.55, M: 87.72 ± 11.45, & S: 101.37 ± 27.12 mg/dl; F= 59.398, p<0.01); and OGTT (L: 104.66 ± 13.81, M: 113.13 ± 20.09, & S: 139.33 ± 49.88 mg/dl; F= 65.265 , p<0.01).
25- At a cutoff point ≥13, the AUSDRISK Arabic version discriminatively identify the undiagnosed DM with high sensitivity (86.11%) and specificity (73.35%), PPV (14.55%), and NPV (99.01%), and AUC (0.887, 95% CI: 0.824 - 0.950).
26- At a cutoff point ≥9, the AUSDRISK Arabic version discriminatively identify PDM with high sensitivity (80.73%) and specificity (58.06%), PPV (41.22%), and NPV (89.21%), and AUC (0.767, 95% CI: 0.727 - 0.807).
27- The test re-test reliability of all 719 participants who were interviewed twice (2 weeks apart) reflected statistically significant positive correlation (Pearson r= 1, p<0.01). Criterion related validity of the whole participants was assessed between the total AUSDRISK Arabic version score and each of the blood glucose tests. It reflected statistically significant positive correlation with FPG (Pearson r= 0.48 and p<0.01) and 2h PG (Pearson r= 0.52 and p<0.01).