Performance of the UK Prospective Diabetes Study Outcomes Model 2 in a Contemporary UK Type 2 Diabetes Trial Cohort

Abstract

Objectives: The UK Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS-OM) developed using 30-year (1977-2007) data from the UKPDS is widely used for health outcomes' projections and economic evaluations of therapies for patients with type 2 diabetes (T2D). Nevertheless, its reliability for contemporary UK T2D populations is unclear. We assessed the performance of version 2 of the model (UKPDS-OM2) using data from A Study of Cardiovascular Events in Diabetes (ASCEND), which followed participants with diabetes in the UK between 2005 and 2017. Methods:The UKPDS-OM2 was used to predict the occurrence of myocardial infarction (MI), other ischemic heart disease, stroke, cardiovascular (CV) death, and other death among the 14 569 participants with T2D in ASCEND, all without previous CV disease at study entry. Calibration (comparison of predicted and observed year-on-year cumulative incidence over 10 years) and discrimination (c-statistics) of the model were assessed for each endpoint. The percentage error in event rates at year 7 (mean duration of follow up) was used to quantify model bias. Results:The UKPDS-OM2 substantially overpredicted MI, stroke, CV death, and other death over the 10-year follow-up period (by 149%, 42%, 269%, and 52%, respectively, at year 7). Discrimination of the model for MI and other ischemic heart disease (c-statistics 0.58 and 0.60, respectively) was poorer than that for other outcomes (c-statistics ranging from 0.66 to 0.72). Conclusions:The UKPDS-OM2 substantially overpredicted risks of key CV outcomes and death in people with T2D in ASCEND. Appropriate adjustments or a new model may be required for assessments of long-term effects of treatments in contemporary T2D cohorts.

Prognostic models for heart failure in patients with type 2 diabetes: a systematic review and meta-analysis

“…The progression of predictors during the course of the disease can be approximated by equations, in case they are not available. Both models showed adequate discrimination, yet with considerably high heterogeneity and tended to overestimate the risk of CHF in multiple validation studies 16 29 30 36–42…”

The WISDOM self‐management intervention: A cost‐effectiveness analysis to support the transformation of type 2 diabetes care in England

“…Another limitation is that the UKPDS model is based on associations between the risk factors and outcomes, rather than causal impacts. However, a recent validation study of the model provides us with confidence about its predictive accuracy 26 . Moreover, it is unknown how WISDOM would impact the measurement of risk factors (i.e., prompt GPs to measure risks in people with outdated measurements) in other settings, if it were to be rolled out.…”

“…However, a recent validation study of the model provides us with confidence about its predictive accuracy. 26 Moreover, it is unknown how WISDOM would impact the measurement of risk factors (i.e., prompt GPs to measure risks in people with outdated measurements) in other settings, if it were to be rolled out. Another limitation is the substantial proportion of missing observations for some risk factors, which may have challenged the successful implementation of multiple imputation.…”

Insulin degludec/liraglutide versus its monotherapy on T2D patients: A lifetime cost-utility analysis in China

“…A cost-utility analysis based on data from six RCTs was conducted using the UK Prospective Diabetes Study Outcome Model version 2 (UKPDS OM2) (Hayes et al, 2013). UKPDS OM2 is a nonproduct-specific computer simulation model that has been validated (Keng et al, 2022) and widely used to extrapolate long-term health and economic outcomes of T2D patients from data from short-term clinical trials. The detail model structure was shown in Supplementary Figure S1.…”