TY - JOUR
T1 - Predicting major outcomes in type 1 diabetes: a model development and validation study
AU - Soedamah-Muthu, S.S.
AU - Vergouwe, Y.
AU - Costacou, T.
AU - Miller, R.G.
AU - Zgibor, J.
AU - Chaturvedi, N.
AU - Snell-Bergeon, J.K.
AU - Maahs, D.M.
AU - Rewers, M.
AU - Forsblom, C.
AU - Harjutsalo, V.
AU - Groop, P.H.
AU - Fuller, J.H.
AU - Moons, K.G.M.
AU - Orchard, T.J.
PY - 2014
Y1 - 2014
N2 - Aims/hypothesis
Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicted these outcomes early in the disease process would help in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts.
Methods
Data were analysed from 1,973 participants with type 1 diabetes followed for 7 years in the EURODIAB Prospective Complications Study. Strong prognostic factors for major outcomes were combined in a Weibull regression model. The performance of the model was tested in three different prospective cohorts: the Pittsburgh Epidemiology of Diabetes Complications study (EDC, n¿=¿554), the Finnish Diabetic Nephropathy study (FinnDiane, n¿=¿2,999) and the Coronary Artery Calcification in Type 1 Diabetes study (CACTI, n¿=¿580). Major outcomes included major CHD, stroke, end-stage renal failure, amputations, blindness and all-cause death.
Results
A total of 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors were age, HbA1c, WHR, albumin/creatinine ratio and HDL-cholesterol level. The discriminative ability of the model was adequate, with a concordance statistic (C-statistic) of 0.74. Discrimination was similar or even better in the independent cohorts, the C-statistics being: EDC, 0.79; FinnDiane, 0.82; and CACTI, 0.73.
Conclusions/interpretation
Our prognostic model, which uses easily accessible clinical features can discriminate between type 1 diabetes patients who have a good or a poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials.
AB - Aims/hypothesis
Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicted these outcomes early in the disease process would help in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts.
Methods
Data were analysed from 1,973 participants with type 1 diabetes followed for 7 years in the EURODIAB Prospective Complications Study. Strong prognostic factors for major outcomes were combined in a Weibull regression model. The performance of the model was tested in three different prospective cohorts: the Pittsburgh Epidemiology of Diabetes Complications study (EDC, n¿=¿554), the Finnish Diabetic Nephropathy study (FinnDiane, n¿=¿2,999) and the Coronary Artery Calcification in Type 1 Diabetes study (CACTI, n¿=¿580). Major outcomes included major CHD, stroke, end-stage renal failure, amputations, blindness and all-cause death.
Results
A total of 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors were age, HbA1c, WHR, albumin/creatinine ratio and HDL-cholesterol level. The discriminative ability of the model was adequate, with a concordance statistic (C-statistic) of 0.74. Discrimination was similar or even better in the independent cohorts, the C-statistics being: EDC, 0.79; FinnDiane, 0.82; and CACTI, 0.73.
Conclusions/interpretation
Our prognostic model, which uses easily accessible clinical features can discriminate between type 1 diabetes patients who have a good or a poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials.
KW - coronary-heart-disease
KW - eurodiab prospective complications
KW - all-cause mortality
KW - cardiovascular-disease
KW - pittsburgh epidemiology
KW - risk-factors
KW - intensive treatment
KW - iddm complications
KW - metabolic syndrome
KW - association
U2 - 10.1007/s00125-014-3358-x
DO - 10.1007/s00125-014-3358-x
M3 - Article
VL - 57
SP - 2304
EP - 2314
JO - Diabetologia
JF - Diabetologia
SN - 0012-186X
IS - 11
ER -
