# Validation of the Finnish Diabetes Risk Score (FINDRISC) in a Central‐European Population for the Prediction of Cumulative Incidence of Type 2 Diabetes Over 8‐Years—Follow‐Up of the Budakalász Health Examination Survey (BHES)

## TL;DR

The Finnish Diabetes Risk Score (FINDRISC) was validated and recalibrated for a Hungarian population, showing improved but limited predictive accuracy for type 2 diabetes over 8 years.

## Contribution

The study recalibrated FINDRISC for a Central-European population and evaluated its performance after omitting some variables.

## Key findings

- Re-estimating weights improved discrimination (AUC 0.68 vs. original 0.66).
- Omission of non-independent variables did not significantly worsen model performance.
- FINDRISC discrimination was worse for individuals aged ≥65 years.

## Abstract

FINDRISC is widely used to assess 10‐year incidence of drug‐treated type 2 diabetes; however, it may require recalibration before implementation in new populations. Thus, we investigated the performance of FINDRISC and recalibrated it in the Hungarian population.

8‐year follow‐up data for incident type 2 diabetes was ascertained from the reimbursement database of Hungary for 2059 diabetes‐free participants of a voluntary survey (2011–2013). Incident diabetes was based on repeated prescription of antidiabetic medications. Discrimination of the original and the recalibrated (multiple logistic regression) FINDRISC was compared using ROC analysis.

279 (13.6%) incident diabetes cases were found. Age, waist circumference, antihypertensive treatment, and history of elevated blood glucose were independent predictors of incident diabetes. Re‐estimating the weights improved discrimination ([AUC]: 0.68 [95% CI 0.65–0.71] vs. original: 0.66 [95% CI 0.63–0.69], p = 0.02). Even after the omission of variables non‐independent predictors of diabetes, the AUC remained better than the original score and similar to the reweighted score (AUC: 0.68 [95% CI 0.65–0.71] vs. original p = 0.04 vs. reweighted model p = 0.83). Discrimination was worse for those ≥ 65 years versus younger people.

Validation and recalibration are important steps before using the FINDRISC in a population different from the derivation cohort. Omission of some variables (physical activity, fruit and vegetable consumption, and family history of diabetes) that are not readily available did not significantly worsen the performance of the model. FINDRISC may not be a good predictor of incident diabetes in older populations.