What is the Impact of Diabetes Risk Scores in the Primary Care Setting?

In recent years, several types of questionnaire-based scores have been devel-oped to help determine a person’s future risk of type 2 diabetes. Little re-search has been done into whether these questionnaires lead to overweight people implementing lifestyle changes or whether they have negative conse-quences, such as anxiety. A new study has now addressed these questions.

The DIfE - German Diabetes Risk Test® tests adults for the risk of developing type 2 diabetes in the next five years. © DZD / DIfE

International guidelines for the prevention and treatment of diabetes often recommend the use of diabetes risk scores to determine the future risk of developing diabetes. Questions relating to factors such as waist circumference, dietary habits, and physical activity are surveyed. However, very few current studies look at the benefits and effects of using risk scores in the primary care setting. A new study from the German Diabetes Center (DDZ), partner of the German Center for Diabetes Research, under the leadership of Prof. Wolfgang Rathmann, Deputy Director of the Institute of Medical Biometry and Epidemiology, has now taken a closer look at this topic: What are the effects of using diabetes risk scores for people who are overweight and have not been diagnosed with diabetes. “This new study is important not only because it helps us better understand the consequences and secondary effects of diabetes prevention measures, but also because it looks at the effects of using these types of questionnaires on the overweight population” explains Prof. Michael Roden, Scientific Director and Executive Board Member of the DDZ. He further explaines that “Our scientists have closely studied how peoples’ behavior changes after completing these types of questionnaires and what conclusions can be drawn to help optimize the process”.

During a health check-up with a family doctor, the participants were separated into two groups: One group was given a standard health check-up (control group) and the other completed the German Diabetes Risk Score questionnaire (intervention group). Primarily, the DDZ researchers were interested in any changes in physical activity in the twelve months following the health check-up. Also, any differences relating to physical (Body Mass Index and waist circumference) or psychological changes (perceived health, anxiety, depression) and motivation to implement lifestyle changes were assessed. After twelve months, only a slight increase in physical activity was observed in the intervention group, such as 30 minutes of moderate activity when riding a bike or carrying light loads three times per week. Regarding the physical and psychological endpoints, no significant differences were observed between the two groups. A slight increase in motivation to implement lifestyle changes (reducing body weight, intensifying physical activity, and healthy eating habits) was observed in the participants in the intervention group compared with those in the control group.

“The study on the efficacy of diabetes risk scores in the primary care setting, long called for by experts, clearly shows that their use, including the classification of these results in the final consultation with the treating physician, is insufficient in promoting physical activity in the affected person groups,” explains Dr. Seidel-Jacobs, Project Manager and Research Associate at the Institute of Medical Biometry and Epidemiology. Several other similar studies confirmed the clinically insignificant influence on the individual risk factors and furthermore found no reduction in cardiovascular events or mortality rates.

“It is possible that the type and intensity of the conversation between the family doctor and the patient, relating to the use of diabetes risk scores, influences the efficacy of the measures,” suggests Prof. Rathmann, while recommending that the researchers carry out more randomized studies referencing the selected consultation technique. Furthermore, Prof. Rathmann emphasized that the use of these types of questionnaires in the primary care setting remains worthwhile. However, when used alone, diabetes risk scores are not sufficient to counteract the increasing number of diabetes cases.

Original publication:
Seidel-Jacobs E,..., Rathmann W. Impact of applying a diabetes risk score in primary care on change in physical activity: a pragmatic cluster randomised trial. Acta Diabetol. 2022 May 13;1-10. doi: 10.1007/s00592-022-01895-y. Online ahead of print