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Validation of the Canadian Diabetes Risk Questionnaire (CANRISK) tool amongyoung African, Caribbean, and Black (ACB) adults living in Canada

Validation of the Canadian Diabetes Risk Questionnaire (CANRISK) tool amongyoung African, Caribbean, and Black (ACB) adults living in Canada

Graphic of 2 African, Caribbean, and Black (ACB) adults

This study examines whether the Canadian Diabetes Risk Questionnaire (CANRISK), a widely used, non-invasive screening tool for identifying risk of type 2 diabetes (T2D) and prediabetes, is valid and appropriate for young African, Caribbean, and Black (ACB) adults aged 18–39 living in Canada.

What this research is about

The research responds to a critical gap. Although CANRISK is extensively used across Canada, it had not previously been validated for young ACB populations, despite evidence that these groups experience a disproportionately high burden of diabetes at younger ages. The research aimed to evaluate whether CANRISK effectively identifies type 2 diabetes risk in this population, which faces disproportionately high diabetes rates but has been underrepresented in previous validation studies.

The article validates the use of CANRISK for young ACB adults in Canada and finds that, with an age-adjusted scoring and a cut-off score of 19, it is an acceptable tool to screen for prediabetes and T2D in this group.

What you need to know

Type 2 diabetes prevalence among young Canadian adults (aged 18-34) has risen dramatically. In less than a decade it has increased 33.3% (from 0.9% in 2015 to 1.2% in 2022). ACB populations face nearly double the diabetes prevalence (12.9%) compared to white populations (6.8%). Young-onset diabetes is particularly concerning because it progresses more rapidly and causes earlier complications than later-onset cases.

Early detection and intervention are particularly crucial for younger individuals and offer greater benefits compared to interventions initiated later on in life. Early detection can prompt timely lifestyle changes and health-seeking behaviours that may return blood sugar to normal levels or at least delay the onset of T2D.

Diabetes prevention efforts for high-risk populations, such as young ACB people, can benefit from screening using risk prediction models. These models use mathematical equations to predict the probability of an individual having or developing a disease. T2D screening models use noninvasive individual-level predictors (such as age, biological sex, health behaviours etc.), are free to use, and can inform individuals on T2D risk factors and enable easy access to medical information. This is particularly important for marginalized racial groups.

CANRISK is the free, non-invasive Canadian questionnaire (12 items) using self-reported risk factors (age, sex, family history, lifestyle, history of high blood pressure/sugar, etc.) and anthropometric measures (BMI, waist circumference) to estimate current risk without blood tests.

Prior validations showed that CANRISK works moderately well for some high‑risk young groups (South Asian, First Nations, Métis) when the cut-off is lowered. However, ACB young adults were underrepresented (n=98) and not specifically validated previously. This research substantially increases the ACB sample (n=722) and incorporates new data into an updated pooled validation.

What researchers found

The CANRISK tool, with a modified cut-off point of 19, is a suitable tool to identify T2D risk among young adults from ACB ethnicities. The research demonstrates that risk prediction models developed for general populations can be effectively adapted for specific ethnic groups through modified cut-off points. As well, the authors illustrate how community-based participatory approaches can successfully collect health data from underrepresented populations.

Despite higher dysglycemia prevalence, young ACB participants reported healthier behaviours overall, such as regular physical activity and daily fruit/vegetable intake, suggesting structural and systemic drivers beyond individual behaviour. Factors beyond family history may be driving diabetes risk in ACB populations.

The study emphasized that with significant lifestyle changes such as improved diet and increased physical activity, remission to normal or to prediabetic glucose levels is achievable for young people, especially in early years, highlighting the importance of early detection.

How can you use this research?

For clinicians and healthcare providers: Adopt the validated CANRISK tool as a standard screening protocol for young ACB adults, applying the cut-off score of 19. Use the tool to initiate conversations about diabetes risk factors and prompt referrals for lifestyle interventions or further testing when scores indicate elevated risk.

For public health agencies and policymakers: Implement CANRISK screening programs specifically targeting young ACB populations as part of diabetes prevention strategies. The successful use of Black health equity principles of Engagement, Governance, Access, and Protection (EGAP) demonstrates that health equity frameworks can facilitate effective data collection and program implementation in racialized communities. Invest in partnerships with Community Health Centres serving ACB populations to deliver culturally responsive screening programs.

For young ACB adults and their families: Individuals can access the free CANRISK questionnaire to assess their own diabetes risk and understand modifiable risk factors. A score of 19 or higher indicates elevated risk and should prompt consultation with healthcare providers about lifestyle changes or further testing. Given that prediabetes often goes undiagnosed due to its asymptomatic nature, proactive screening is particularly important for those with risk factors like family history, higher BMI, or history of high blood pressure.

What did the researchers do?

Methodology: The study conducted Phase III of CANRISK data collection from 2023-2024, recruiting young ACB individuals (ages 18-39) primarily in Toronto, Ontario, and combined this with previously gathered data from Phase I (2007-2011) and Phase II (2013-2014). All participants completed the CANRISK questionnaire and underwent the Oral Glucose Tolerance Test (OGTT) for dysglycemia assessment. Researchers obtained a sample of 722 young individuals of ACB ethnicities and a total of 3,958 young individuals from all ethnicities.

Analysis: Researchers conducted descriptive analyses of all CANRISK predictors and dysglycemia prevalence, calculated discriminatory ability metrics (AUC, sensitivity, specificity, PPV, NPV), and tested multiple cut-points (17-21) using Youden’s Index to confirm the optimal threshold.