Development and validation of a Jordan-specific risk score for type 2 diabetes mellitus

Jordan has a high prevalence of type 2 diabetes mellitus (T2DM), but it is estimated that nearly half of all cases in the Middle East and North Africa region remain undiagnosed. This study aimed to develop, validate and assess the diagnostic performance of a diabetes risk score to identify Jordanians at high risk of T2DM.

Random samples of 5000 Jordanians aged 20-79 years were simulated at different time points using an existing mathematical model describing T2DM epidemiology in Jordan. The risk score was derived through logistic regression applied to the simulated samples, using age, sex, obesity, smoking and physical inactivity as predictive variables. Cut-off values were determined based on the maximum sum of sensitivity and specificity.

In 2020, the estimated area under the curve (AUC), sensitivity and specificity of the derived Jordan Diabetes Risk Score were 0.79 (95% CI: 0.77 to 0.80), 78.7% (95% CI: 77.5 to 79.8%) and 64.2% (95% CI: 62.9 to 65.6%), respectively. The positive and negative predictive values were 29.7% (95% CI: 28.4 to 31.0%) and 94.0% (95% CI: 93.3 to 94.7%), with 42.7% of Jordanians at high risk for diabetes. Similar diagnostic metrics were observed for the 2030 and 2050 risk scores, with AUCs of 0.78 (95% CI: 0.77 to 0.80) and 0.77 (95% CI: 0.76 to 0.79), respectively. The performance of the derived model-based score was comparable to a survey-based score and demonstrated better performance within the Jordanian population compared with existing regional and international scores.

The Jordan Diabetes Risk Score demonstrated strong diagnostic performance, offering an effective, non-invasive and accessible tool for diabetes screening. This tool can facilitate early detection, timely intervention and increased awareness, ultimately aiming to reduce the burden of T2DM and its complications in Jordan.