Research on risk factors for diabetes (DM) is growing. Identification of these risk factors aims to prevent DM as early as possible. This study intends to identify the utilization of the Finnish diabetes risk score (FINDRISC) and its development using bibliometric analysis. The keywords FINDRISC AND Diabetes were used to search for articles published in 2005-2021 in PubMed. A total of 249 articles were analyzed based on the number of publications per year, journals that publish the papers, number of publications by author and year of publication, number of publications by affiliation and year of publication, number of publications by country of origin of authors and year of publication, number of keywords, number of citations, types of articles, specific topics, and theme mapping. The data visualization was obtained from the Scopus database and the VOSviewer and Biblioshiny applications. Despite the increase in publications, the number of publications on FINDRISC in DM patients is still very few per year, with 92.8 being the primary study. Based on clusters of the country of origin, publications are still dominated by researchers from countries in the European region, and the researchers intensely relate to each other through citations. Research themes related to FINDRISC are not limited to DM risk factors. This study is the first study of a bibliometric analysis of the utilization of FINRISC in DM patients. The analysis results can be used to evaluate existing research gaps and identify future research opportunities.

TheInternational Diabetes Federation estimates that there has been an increase inthe number of people with diabetes by 21% between 2013 and 20191,2. The number of people with diabetes is estimated to be 463 million in 2019and will increase to 700 million by 2045. It is estimated that 50.1% of peoplewith diabetes are still undetected3. In addition, people with prediabetes as a high-risk group for developingdiabetes usually go undetected clinically4. Improper and late intervention in this group will cause prediabetes todevelop progressively into type 2 diabetes mellitus within 2-3 years, which in70% of patients will remain throughout their lives5. Diabetes mellitus will burden patients, families, and the health caresystem6.

A systematicreview and meta-analysis have discovered that lifestyle change interventionssuch as exercise, weight loss, and dietary management can prevent prediabetesand even slow the progression of type 2 diabetes7. Identification of individuals with prediabetes in the population isessential. However, prediabetes is difficult to trace because it isasymptomatic. Therefore, an instrument is needed to identify individuals with ahigh risk of developing type 2 diabetes so that lifestyle change interventionscan be more targeted8.

The Finnishdiabetes risk score (FINDRISC) is an instrument in the form of a questionnaireaimed at identifying individuals with a high risk of developing diabetes9. The question items in this instrument are a set of the main risk factorsfor type 2 diabetes. Initially, this instrument was developed to detect therisk of diabetes in the next ten years in the Caucasian population. However,this instrument has been translated, adapted, and validated over time so it canbe applied to other populations, such as Asian populations10-12. Several other studies have also compared the performance of the originalversion of FINDRISC with the simplified version of FINDRISC13,14.

A study showedthat FINDRISC could screen individuals at high risk of developing type 2diabetes and that lifestyle intervention for these individuals effectivelytreats their obesity, one of the risk factors for type 2 diabetes15. In addition to its ability to identify individuals at high risk ofdeveloping diabetes, several studies have also evaluated the ability ofFINDRISC to detect individuals with undiagnosed type 2 diabetes, the presenceof impaired glucose tolerance, and the risk of developing metabolic syndrome16-18. Individuals with higher FINDRISC are also associated with a decreasedquality of life19.

No studiesprecisely quantify the development of research trends toward the FINDRISCinstrument. Bibliometric analysis can be used for this purpose and has beenwidely used in many disciplines to observe research trends on a particulartopic, population, or region. It can also be used to identify the potential forfuture research development. Therefore, this study aimed to identify theutilization of the FINDRISC using bibliometric analysis.

Bibliometricanalysis was performed by conducting a literature search on PubMed and Scopuswith the keywords: "FINDRISC" AND "Diabetes". A total of249 articles were obtained and analyzed based on the number of publications peryear, journals that publish the articles, number of publications by author andyear of publication, number of publications based on affiliation and year ofpublication, number of publications by country of origin and year ofpublication, number of keywords per year, number of citations per year, typesof articles, specific topics, and theme mapping. The data visualization wasobtained from the Scopus database with the VOSviewer and Biblioshinyapplications.

Data analysis andvisualization

The data in theScopus database are visualized automatically. In contrast, we used VOSviewerand Biblioshiny to show data from the PubMed database. Only four of the 11figures in this article are obtained from Scopus, notably Figures 1,2,8, and 9. We used VOSviewer/Biblioshinyto visualize the rest of the data from PubMed.

From the literaturesearch on PubMed and Scopus, the same 249 articles were obtained, with theannual distribution shown in Figure 1. Despite the increase in thenumber of publications, the number of publications on the topic of FINDRISC inpatients with diabetes mellitus is still very few per year, where every year,only less than 35 articles are published. The highest number of publishedarticles, 34 articles, was in 2020.

Figure1. Number of articles on the topics of FINDRISC and diabetesfor the period 2005-2021.

A bibliometricanalysis of the number of publications related to the utilization of FINDRISCin patients with diabetes revealed an increasing trend since 2005. The overviewof publication productivity based on country clusters showed that thoseresearchers from European countries still dominate publications. This situationis likely because the FINDRISC instrument was first developed in a populationat high risk of developing diabetes in Finland20,21. In 2003, a newDiabetes Risk Screening program was started in Finland, with the development ofan instrument called the Diabetes Risk Score instrument. Furthermore, the firstpublication discussing this topic was in 200522. This finding is inline with the Word Cloud analysis (Figure 10), which shows that the word"Finland" is the word with the highest frequency of occurrence.

Figure 2 shows the journalsthat published articles related to FINDRISC and diabetes from 2005-2021. PLoS Onewas the journal that published the most articles on this topic in 2016. In2021, Diabetes Research and Clinical Practice and Primary Care Diabetespublished three articles on FINDRISC and diabetes. Research topics regardingFINDRISC and diabetes still have the potential to be explored, as evidenced byPLoS One publishing many articles related to FINDRISC and diabetes.

Figure 3 displays theauthors of articles related to FINDRISC and diabetes based on the year ofpublication and the number of publications. There are eight clusters of authorsof articles that are also related to each other. The number of relationshipsbetween authors is 344. The authors with yellow circles are included in thelatest publication cluster, although the number of published articles is stilllimited. Tuomilehto was the author with the most publications around 2012-2016,followed by Lindstrom at the same time range.

Figure 4 displays the numberof articles by institutional affiliation of the author and year of publication.There are 10 relations between institutions to which the authors are affiliated,and these institutions are divided into three clusters based on the year ofpublication. Research in 2018 was conducted mainly by the Diabetes ResearchGroup, Dasman Diabetes Institute, and the Department of Chronic Disease. Theinstitution that conducted the most extended years of research was the NationalInstitute for Health.

Figure2. Number of published articles related to FINDRISC anddiabetes by journal.

Figure3. Number of publications on the topics of FINDRISC anddiabetes for the period 2005-2021 by author and year of publication.

Figure4. Number of articles with FINDRISC and diabetes topics inpublications for the period 2005-2021 by author affiliation and year ofpublication.

Figure 5 shows the number ofarticles by country of origin of the author and year of publication. There arefive clusters of countries involved based on the year of publication, with 111relationships with each other. Recent publications have been by authors from SaudiArabia, Brazil, Venezuela, Greece, Belgium, and Colombia, although the numberof publications is still relatively small. Most publications were by authorsfrom Finland in 2015. This is understandable because FINDRISC originates fromFinland.

Figure5. Mapping of publications with FINDRISC and Diabetes topicsfor the period 2005-2021 by country of origin of author and year of publication.

Figure 6 shows the keywordsused by the authors. There are five clusters of these keywords based on theyear of publication with 199 relationships with each other. The keyword"diabetes" appeared in 2017 and is almost the same as "type 2diabetes," which appeared in 2015.

Figure6. Mapping of keywords related to FINDRISC and Diabetestopics in publications for the period 2005-2021 based on keyword type and yearof publication.

Since 2015, articleshave been published by researchers from countries in the Americas and Asia.Even though the number of articles is still relatively small, the researcherswho research the topic of FINDRISC seem to be intensely related and interactwith each other through citations. The lack of publications regarding theutilization of FINDRISC in Asian populations provides an opportunity to conducta comparative analysis of the validity of the FINDRISC screening instrument inAsian populations. The different characteristics of populations with diabetesmellitus in Europe and Asia are very important to understand by clinicians andpolicymakers for the prevention of risk factors and management of diabetes.Compared to the European population, the incidence of diabetes in the Asianpopulation is dominated by young people with insulin resistance due toexcessive accumulation of body fat and abdominal obesity23.

Figure 7 exhibits a mappingof citations by author and year of publication. There are six clusters based onthe year of publication with 115 relationships between authors. The article byTuomilehto was most cited in 2014, while the most cited articles published in2020 were those by Cardon and Iotova. Figure 8 shows the types of publishedarticles, most of which are research articles (92.8%). While Figure 9 displays thesubject areas of the research, most of which are medicine (58.4%).

Figure7. Mapping of citations related to FINDRISC and Diabetestopics in publications for the period 2005-2021 by author and year ofpublication.

Figure8. Types of articles on the topics of FINDRISC and Diabetesin publications for the period 2005-2021.

Figure9. Subject areas of research with the topics of FINDRISC and Diabetes in publicationsfor the period 2005-2021.

The overview of thetypes of published articles reveals that most of the documents in this bibliometricanalysis are original papers or research articles. The number of reviewarticles was found to be less than 5%. It indicates an opportunity to conduct asystematic literature review, scoping review, or meta-analysis method toexamine the validity and performance of FINDRISC as an instrument for screeningvarious populations at risk of developing diabetes or having prediabetes. Inaddition, the existing publications that test the validity of FINDRISC in thenew population mainly used a cross-sectional design, and there are still fewpublications that used prospective data24.

Figure 10 shows the mostfrequently occurring words in publications about FINDRISC and diabetes."Finland" is the most mentioned word in the publications. Figure 11 is a mapping ofthemes based on articles found in publications for 2005-2021. The themeclusters can be seen from the color difference. The cluster in gray is thecluster of most discussed themes in research on FINDRISC and diabetes, whichinclude: consensus, diet restriction, clinical effectiveness, Spain,questionnaire, glucose blood level, and others.

Figure10. Word Cloud in research related to FINDRISC and Diabetes inpublications for the period 2005-2021.

Figure11. Mapping of themes of research with the topics of FINDRISCand Diabetes in publications for the period 2005-2021.

It seems that the researchthemes related to FINDRISC are not only limited to immediate diabetes riskfactors such as diet restriction, glucose blood level, cardiovascular risk, andlifestyle modification but also intersect with broader themes such as diseasecourse, mortality, morbidity, and costs. Several themes that were alsodiscussed, such as screening tests, high-risk patients, and clinicaleffectiveness, indicate that the FINDRISC instrument has the potential to bestudied further at the clinical level and community level, and it is possiblefor this instrument to be used to screen for other metabolic disorders such asmetabolic syndrome. In addition, the attempt to include FINDRISC in thepractice guidelines for primary medical care has become a growing theme25. Acost-effectiveness analysis is necessary for the evaluation26.

On the other hand,although nearly 60% of the subject areas of research on FINDRISC and diabetesare medicine, research from other subject areas such as biochemistry, nursing,dentistry, agriculture, pharmacology, and others provides opportunities forcollaborative research on this topic in the future. Various reports on theresults of studies related to FINDRISC are still popular and exciting topublish. This is indicated by articles on this topic continuously published by reputableand prestigious journals such as PLoS One, BMC Public Health, and Primary CareDiabetes.

One limitation ofthis study is that the only databases used were PubMed and Scopus. Scopus willrepeat the number of articles based on contributing authors from differentcountries in one article, so some articles may be counted multiple times if thecontributing authors are from several countries27. Nevertheless, thisis sufficient to serve as a basis for evaluating the utilization of FINDRISC indiabetes screening and identifying research gaps and future researchopportunities. Opportunities to conduct research using Indonesia's FINDRISC instrumentare still ample. This instrument can be one of the government's considerations,especially in measures for the early detection of diabetes, for example, in theintegrated post guidance for non-communicable diseases (Pos Binaan Terpadu;Posbindu) and the Healthy Campus program initiated by the Ministry ofHealth of the Republic of Indonesia.

Despitethe increase in publications, the number of publications on FINDRISC inpatients with diabetes mellitus per year is still relatively small, with 92.8%of publications being primary studies. The publications are still dominated bythose of researchers from countries in the European region, and theseresearchers intensely relate to each other and interact with each other throughcitations. Research themes related to FINDRISC are not limited to diabetes riskfactors.

We want to thank allthose who have helped us in the data collection process and the process ofwriting this article. Also, thanks to the Office of Research and Publication,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada,Yogyakarta, Indonesia.

DAP was the first to propose this research concept. Then, DAP and MRRcollect and analyze data. In addition to being the corresponding author, BAalso ensures that the final draft of the manuscript complies with theguidelines of the intended journal. ZZ contributes to datavisualization. SR support in budgeting. All authors provided feedbackfrom the initial draft to the final manuscript and approved the overall process.

None.

Theauthors declare no conflict of interest.

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