Aims: Robust diabetes risk estimates in Asian patients with impaired glucose tolerance (IGT) and coronary heart disease (CHD) are lacking. We developed a Chinese type 2 diabetes risk calculator using Acarbose Cardiovascular Evaluation (ACE) trial data.
Methods: There were 3105 placebo-treated ACE participants with requisite data for model development. Clinically relevant variables, and those showing nominal univariate association with new-onset diabetes (P < .10), were entered into BASIC (clinical variables only), EXTENDED (clinical variables plus routinely available laboratory results), and FULL (all candidate variables) logistic regression models. External validation was performed using the Luzhou prospective cohort of 1088 Chinese patients with IGT.
Results: Over median 5.0 years, 493 (15.9%) ACE participants developed diabetes. Lower age, higher body mass index, and use of corticosteroids or thiazide diuretics were associated with higher diabetes risk. C-statistics for the BASIC (using these variables), EXTENDED (adding male sex, fasting plasma glucose, 2-hour glucose, and HbA1c), and FULL models were 0.610, 0.757, and 0.761 respectively. The EXTENDED model predicted a lower 13.9% 5-year diabetes risk in the Luzhou cohort than observed (35.2%, 95% confidence interval 31.3%-39.5%, C-statistic 0.643).
Conclusion: A risk prediction model using routinely available clinical variables can be used to estimate diabetes risk in Chinese people with CHD and IGT.
目的: 对亚洲冠心病合并糖耐量受损人群, 目前还缺乏可靠的糖尿病风险估算。因此我们利用阿卡波糖心血管评估(ACE)试验数据, 建立了一个中国糖尿病风险计算工具。 方法: 建模人群为ACE研究安慰剂组并有建模所需的完整数据的受试者, 共有3105名。临床相关变量和单因素分析中与新发糖尿病有显著相关的变量(P<0.10)作为候选变量, 用于建立基础模型(仅有临床变量)、扩展模型(临床变量加上常用的实验室指标)和完全模型(所有候选变量)。利用四川泸州前瞻性队列中的1088例IGT受试者进行模型外部验证。 结果: 在5.0年的中位随访中, 共有493名(15.9%)ACE受试者进展为糖尿病。较低的年龄、较高的体重指数、使用皮质类固醇或噻嗪类利尿剂均与较高的糖尿病风险相关。基础模型(使用以上变量)、扩展模型(加上男性、空腹血糖、2小时血糖和HbA1c)和完整模型的C统计量分别为0.610、0.757和0.761。扩展模型预测泸州队列5年糖尿病风险为13.9%, 比实际观察低[35.2% (95%CI 31.3%-39.5%), C统计量:0.643]。 结论: 使用常规临床变量的风险预测模型可用于估计中国成人冠心病合并糖耐量受损人群的糖尿病风险。.
Keywords: 2型糖尿病; coronary heart disease; impaired glucose tolerance; risk prediction; type 2 diabetes mellitus; 冠心病; 糖耐量受损; 风险预测.
© 2021 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.