Adapting existing diabetes risk scores for an Asian population: a risk score for detecting undiagnosed diabetes in the Mongolian population.

BACKGROUND: Most of the commonly used diabetes mellitus screening tools and risk scores have been developed with American or European populations in mind. Their applicability, therefore, to low and middle-income countries remains unquantified. Simultaneously, low and middle-income countries including Mongolia are currently witnessing rising diabetes prevalence. This research aims to develop and validate a diabetes risk score for the screening of undiagnosed type 2 diabetes mellitus in the Mongolian adult population. METHODS: Blood glucose measurements from 1018 Mongolians, as well as information on demography and risk factors prevalence was drawn from 2009 STEPS data. Existing risk scores were applied, measuring sensitivity using area under ROC-curves. Logistic regression models were used to identify additional independent predictors for undiagnosed diabetes. Finally, a new risk score was developed and Hosmer-Lemeshow tests were used to evaluate the agreement between the observed and predicted prevalence. RESULTS: The performance of existing risk scores to identify undiagnosed diabetes was moderate; with the area under ROC curves between 61-64 %. In addition to well-established risk factors, three new independent predictors for undiagnosed diabetes were identified. Incorporating these into a new risk score, the area under ROC curves increased to 77 % (95 % CI 71 %-82 %). CONCLUSIONS: Existing European or American diabetes risk tools cannot be adopted in Asian countries without prior validation in the specific population. With this in mind, a low-cost, reliable screening tool for undiagnosed diabetes was developed and internally validated for Mongolians. The potential for cost and morbidity savings could be significant.

Mongolia's Public Spending On Noncommunicable Diseases Is Similar To The Spending Of Higher-Income Countries.

Although there is increased recognition of the global challenge posed by noncommunicable diseases (NCDs), translating that awareness into resources for action requires better data than typically available in low- and middle-income countries. One middle-income country that does have good-quality information is Mongolia. Using detailed administrative data from Mongolia and supplementary survey-based information, we estimated public spending on four NCDs in Mongolia and reached four main conclusions. First, Mongolia's public spending patterns on NCDs are similar to NCD spending observed in countries with much higher per capita incomes. Second, public spending for NCDs is low relative to the NCD disease burden in Mongolia. Third, public-sector NCD spending is dominated by inpatient care and hospital-based specialist outpatient services, which suggests inefficiency in resource use. Finally, while public spending on cardiovascular disease is evenly distributed across regions, for cancers it is heavily concentrated in the nation's capital.