Waist circumference home measurement--a device to find out patients in cardiovascular risk

Background: New strategies are needed to prevent the globalepidemic of diabetes and subsequent rise in cardiovascular diseases.We describe a community-based, two-stage screening strategyusing home waist circumference measurement and a risk factorquestionnaire as a primary screening tool. Methods: We maileda tape for measurement of waist and a risk factor questionnaireto every inhabitant aged 45–70 years living in the ruraltown of Harjavalta in Finland. Thereafter we performed an oralglucose tolerance test, anthropometric variables and blood pressureof subjects having at least one risk factor for type 2 diabetesor cardiovascular disease. People with previously known diabetesor vascular disease were excluded. Results: Seventy-three percent(2085/2856) of the invited inhabitants participated, and 84%of the respondents had at least one pre-specified risk factor.Waist circumference 80 cm in women and 94 cm in men (n = 1168),positive metabolic syndrome criteria of the International DiabetesFederation (n = 681) or the Finnish Diabetes Risk Score questionnaire12 points (n = 697) identified 95, 92 and 63% of the new casesof type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively.Conclusion: The International Diabetes Federation criteria forelevated waist circumference are very sensitive but lack specificityin diagnosing glucose disorders. The criteria for metabolicsyndrome and the Finnish Diabetes Risk Score questionnaire aremore efficient tools for the selection of patients for furtherrisk stratification in general practise.