A Risk Score for Predicting the Incidence of Type 2 Diabetes in a Middle-Aged Korean Cohort

Abstract

Background:The aim of this study was to develop a risk score to predict the 4-year risk of diabetes in a middleaged Korean cohort. Methods and Results:Participants without diabetes (6,342 participants, aged 40-69 years) were included and biennial follow ups were conducted. A logistic regression analysis was used to construct the models. The basic model was based on simple information such as age, parental or sibling history of diabetes, smoking status, body mass index, and hypertension, while clinical model 1 was constructed by adding biochemical tests such as fasting plasma glucose, high-density lipoprotein-cholesterol and triglycerides to the basic model; clinical model 2 further added glycated hemoglobin (HbA1c) to clinical model 1. The model accuracy was assessed using area under a receiver operating characteristic (AROC) curve and the Hosmer-Lemeshow statistics. Both net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to determine the contribution of HbA1c. Two clinical models improved model discrimination (AROC=0.75 and 0.77) when compared with the basic model (AROC=0.65). The addition of HbA1c to clinical model 1 increased AROC by only 0.02 despite its high impact on the prediction of diabetes (odds ratio=2.66). However, the NRI and IDI were significantly improved with the addition of HbA1c. Therefore, a risk score system was developed to estimate the 4-year risk of diabetes based on clinical model 2. Conclusions:A risk score derived from simple biochemical examinations including HbA1c can help identify those at a high risk of diabetes in a middle-aged Korean cohort. (Circ J 2012; 76: 1904 - 1910

Development of a New Risk Score for Incident Type 2 Diabetes Using Updated Diagnostic Criteria in Middle-Aged and Older Chinese

“…They also diagnosed T2DM by using HbA1c and FPG criteria [16]. On the other hand, other compared risk models, including the models developed in other Chinese populations, were built on FPG and/or 2-h OGTT based T2DM diagnostic criteria [10]–[15], which may partially explain the low prediction power of those models, since they lacked a sizable proportion of T2DM cases detected by HbA1c alone. Additionally, none of these eastern Asian models has included CRP as a predictive factor.…”

“…The C statistic, which is identical to AUC for binary outcomes such as T2DM, was also calculated for several reported risk models developed in prospective studies in eastern Asians, including Chinese (Sun 2009 [10], Chuang 2011 [12], and Liu 2011[13]), Japanese (Doi 2011 [14], and Heianza 2012 [16]) and Koreans (Lim 2012 [15]). The calibration feature of the prediction models was estimated by Hosmer-Lemeshow test, in which a non-significant P value indicates good agreement between observed outcomes and model based predictions.…”

Development of a new scoring system for predicting the 5 year incidence of type 2 diabetes in Japan: the Toranomon Hospital Health Management Center Study 6 (TOPICS 6)

“…Recent prospective studies have examined the utility of introducing HbA 1c testing for predicting diabetes [15,16,[23][24][25][26][27], and some reports have described the development of models to predict future diabetes using blood variables including FPG and HbA 1c [15,25,29]. More recently and concomitantly with the preparation of this manuscript, a risk score that concurrently included measurements of FPG, HbA 1c and other biochemical markers was reported in a Korean population [40]. However, whether HbA 1c and FPG are equivalent tools for prediction in risk scores, and whether their combination provides a distinct advantage, are important and practical questions at the present time, particularly given the energy expended and emphasis placed on establishing programmes for primary prevention.…”

Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c

“…We raised the issue that prediabetes was largely increased and had a prevalence of almost 40% in the Korean population aged ≥30 years using new diagnostic criteria of diabetes. In a prospective cohort study, the 4-year risk of diabetes in subjects with HbA1c of 5.5% to 6.4% was 2.66 times greater compared to patients with HbA1c level <5.5% [32]. In another prospective, community-based cohort study, an HbA1c cutoff of 5.6% was appropriate for the identification of patients at risk of developing diabetes [33].…”