Many people with diabetes are asymptomatic and remain undiagnosed until serious complications have developed. To address this health issue, a research team at LKS Faculty of Medicine, The University of Hong Kong (HKUMed), has developed a simple risk score, using the findings of “The Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS)”, for identifying individuals at risk of undiagnosed diabetes and encouraging early diagnosis in high-risk individuals. The Non-invasive Diabetes Score (NDS) is calculated on the basis of age, body height, body weight and high blood pressure. The research team has also developed a smartphone app “HK CRISPS Health Risk Engines” to facilitate the calculation of NDS and the prediction of heart attack/stroke and cancer.
Non-invasive Diabetes Score (NDS)
Diabetes mellitus is an increasingly prevalent health problem affecting one in 11 individuals worldwide. High blood sugar can cause damage to many organs in our body, leading to chronic diabetic complications such as kidney failure, eye problems and cardiovascular diseases (coronary heart disease and stroke). Indeed, diabetes is the leading cause of blindness and kidney failure in our population. People with diabetes also have several times the risk of cardiovascular diseases, compared to those without. However, many people with diabetes are asymptomatic and remain undiagnosed until such complications have developed. Early diagnosis in high-risk individuals is therefore important.
The Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS), led by researchers of HKUMed, was the first population-based study with comprehensive assessment for cardiovascular risk factors, including diabetes, among Hong Kong Chinese. The research, commenced in 1995-96, involved around 2,000 participants in follow-up study in the subsequent 20 years to track their development of these risk factors and cardiovascular diseases. The findings have been published in medical journals including Journal of Diabetes Investigation (JDI), Diabetes Care, Hypertension, Circulation and Nature Communications. Recently, based on their findings published in JDI [link to the publication], the research team has developed the NDS for identifying individuals at risk of undiagnosed diabetes.
Hypertension, age and body mass index were the top independent risk factors selected to develop the NDS, with ≥28 out of 50 NDS points considered as high-risk for undiagnosed diabetes. Based on the research findings, the research team advises that individuals with NDS 28 or higher undergo blood tests for diabetes, and even if they are initially tested to have no diabetes, they should repeat the testing for diabetes at regular intervals. The research team recommends that the testing interval should be based on their NDS score. Those with NDS 28-30, 31-37, 38 or more, should undergo blood test for diabetes every 3, 2 and 1 year, respectively. The researchers believe that the NDS is a simple and user-friendly screening tool that is suitable for promoting the regular evaluation for the risk of diabetes and early diagnosis of this common health condition.
Interpretation of the Non-invasive Diabetes Score (NDS)
|NDS||Risk Level for Undiagnosed Diabetes||Health Recommendation|
Equal to / higher than 28
Lower than 28
Launch of the “HK CRISPS Health Risk Engines” smartphone app
The research team has developed a smartphone app “HK CRISPS Health Risk Engines” to facilitate the calculation of NDS. Moreover, this app also contains other risk engines for the prediction of heart attack/stroke and cancer, based on CRISPS. Users simply input basic health information and follow the in-app instructions to calculate their health risks. Health advice comes along with the results of each risk assessment. Users who are assessed to be “high risk” are advised to seek medical advice for further investigations, while other “lower risk” users are encouraged to keep up with healthy lifestyle and evaluate their health risks with this app at regular intervals. The app allows the creation of a maximum of six user accounts per smartphone. All records are kept offline and users can track their own records from the app at any time.
The “HK CRISPS Health Risk Engines” app supports both English and Chinese versions, and is compatible with both iOS and Android smartphones. It is now available for free download at Apple App Store and Google Play Store:
N-CRISPS – A new, contemporary population-based cardiovascular risk factor prevalence study
One of the lead researchers of the study, Professor Karen Lam Siu-ling, Rosie TT Young Professor in Endocrinology and Metabolism, Chair Professor in Medicine, Department of Medicine, HKUMed and Clinical Director of the State Key Laboratory of Pharmaceutical Biotechnology, HKU, also announced the commencement of N-CRISPS, a new, contemporary population-based cardiovascular risk factor prevalence study. Professor Karen Lam Siu-ling remarked, “Over the past 20 years, there have been major changes in the lifestyle, level of health literacy, and the overall standard of medical care in Hong Kong. However, cardiovascular diseases remain the second most common cause of death, behind cancers, accounting for 20.2% of the overall mortality in both 2015 and 2016. It is therefore timely that a new community-based study be conducted to determine the up-dated sex and age-stratified prevalence of cardiovascular risk factors, including diabetes, of Hong Kong population.”
N-CRISPS has started since December 2019. The methodology is similar to CRISPS1 but involving a larger number of participants, up to 4,000 over four years. Mail invitations are sent to residents of randomly selected households registered at the Census and Statistics Department. Participants in this study will need to attend a a free and comprehensive health check for the presence of diabetes, high blood pressure, high cholesterol, anaemia and abnormal function of the liver or kidney. An electrocardiogram (ECG) will also be performed.
N-CRISPS is funded by the Health and Medical Research Fund, Food and Health Bureau, Government of Hong Kong Special Administrative Region.
For enquiry about N-CRISPS, please visit the website (ncrisps.hku.hk/wp) or facebook page (facebook.com/HKUNCrisps).
About the research team
This study on diabetes risk prediction in Hong Kong Chinese was led by Professor Karen Lam Siu-ling, Rosie TT Young Professor in Endocrinology and Metabolism, Chair Professor in Medicine, Department of Medicine, HKUMed and Clinical Director of the State Key Laboratory of Pharmaceutical Biotechnology, HKU; Dr Woo Yu-cho, Honorary Clinical Associate Professor and Dr Paul Lee Chi-ho, Clinical Assistant Professor of the Department of Medicine, HKUMed.
CRISPS was supported in the past two decades by funds from the Health and Medical Research Fund, Food and Health Bureau; Research Grants Council, Government of Hong Kong Special Administrative Region;and private donations.
Please contact LKS Faculty of Medicine of The University of Hong Kong by email (firstname.lastname@example.org).