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External validation of the UK Prospective Diabetes Study (UKPDS) risk engine in patients with type 2 diabetes.
| Content Provider | Europe PMC |
|---|---|
| Author | van Dieren, S. Peelen, L. M. Nöthlings, U. van der Schouw, Y. T. Rutten, G. E. H. M. Spijkerman, A. M. W. van der A, D. L. Sluik, D. Boeing, H. Moons, K. G. M. Beulens, J. W. J. |
| Abstract | Aims/hypothesisTreatment guidelines recommend the UK Prospective Diabetes Study (UKPDS) risk engine for predicting cardiovascular risk in patients with type 2 diabetes, although validation studies showed moderate performance. The methods used in these validation studies were diverse, however, and sometimes insufficient. Hence, we assessed the discrimination and calibration of the UKPDS risk engine to predict 4, 5, 6 and 8 year cardiovascular risk in patients with type 2 diabetes.MethodsThe cohort included 1,622 patients with type 2 diabetes. During a mean follow-up of 8 years, patients were followed for incidence of CHD and cardiovascular disease (CVD). Discrimination and calibration were assessed for 4, 5, 6 and 8 year risk. Discrimination was examined using the c-statistic and calibration by visually inspecting calibration plots and calculating the Hosmer–Lemeshow χ2 statistic.ResultsThe UKPDS risk engine showed moderate to poor discrimination for both CHD and CVD (c-statistic of 0.66 for both 5 year CHD and CVD risks), and an overestimation of the risk (224% and 112%). The calibration of the UKPDS risk engine was slightly better for patients with type 2 diabetes who had been diagnosed with diabetes more than 10 years ago compared with patients diagnosed more recently, particularly for 4 and 5 year predicted CVD and CHD risks. Discrimination for these periods was still moderate to poor.Conclusions/interpretationWe observed that the UKPDS risk engine overestimates CHD and CVD risk. The discriminative ability of this model is moderate, irrespective of various subgroup analyses. To enhance the prediction of CVD in patients with type 2 diabetes, this model should be updated.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-010-1960-0) contains supplementary material, which is available to authorised users. |
| ISSN | 0012186X |
| Journal | Diabetologia |
| Volume Number | 54 |
| PubMed Central reference number | PMC3017299 |
| Issue Number | 2 |
| PubMed reference number | 21076956 |
| e-ISSN | 14320428 |
| DOI | 10.1007/s00125-010-1960-0 |
| Language | English |
| Publisher | Springer-Verlag |
| Publisher Date | 2010-11-14 |
| Publisher Place | Berlin/Heidelberg |
| Access Restriction | Open |
| Rights License | This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. © The Author(s) 2010 |
| Subject Keyword | Calibration Cardiovascular disease Coronary heart disease Discrimination Epidemiology Multiple imputation Prediction Type 2 diabetes mellitus Validation |
| Content Type | Text |
| Resource Type | Article |
| Subject | Endocrinology, Diabetes and Metabolism Internal Medicine |
