Prediction of morbidity and mortality in patients with type 2 diabetes

Abstract

Introduction. The objective of this study was to create a tool that accurately predicts the risk of morbidity and mortality in patients with type 2 diabetes according to an oral hypoglycemic agent.Materials and Methods. The model was based on a cohort of 33,067 patients with type 2 diabetes who were prescribed a single oral hypoglycemic agent at the Cleveland Clinic between 1998 and 2006. Competing risk regression models were created for coronary heart disease (CHD), heart failure, and stroke, while a Cox regression model was created for mortality. Propensity scores were used to account for possible treatment bias. A prediction tool was created and internally validated using tenfold cross-validation. The results were compared to a Framingham model and a model based on the United Kingdom Prospective Diabetes Study (UKPDS) for CHD and stroke, respectively.Results and Discussion. Median follow-up for the mortality outcome was 769 days. The numbers of patients experiencing events were as follows: CHD (3062), heart failure (1408), stroke (1451), and mortality (3661). The prediction tools demonstrated the following concordance indices (c-statistics) for the specific outcomes: CHD (0.730), heart failure (0.753), stroke (0.688), and mortality (0.719). The prediction tool was superior to the Framingham model at predicting CHD and was at least as accurate as the UKPDS model at predicting stroke.Conclusions. We created an accurate tool for predicting the risk of stroke, coronary heart disease, heart failure, and death in patients with type 2 diabetes. The calculator is available online at under the heading “Type 2 Diabetes” and entitled, “Predicting 5-Year Morbidity and Mortality.” This may be a valuable tool to aid the clinician’s choice of an oral hypoglycemic, to better inform patients, and to motivate dialogue between physician and patient.

Estimation of Mortality Risk in Type 2 Diabetic Patients (ENFORCE): An Inexpensive and Parsimonious Prediction Model

“…Several other models have been so far described to predict all-cause mortality in patients with type 2 diabetes (5,6,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Some of them lack formal, independent and external validation (20-24).…”

Cardiovascular Biomarkers and Calculated Cardiovascular Risk in Orally Treated Type 2 Diabetes Patients: Is There a Link?

“…However, a diagnosis of T2D may not be a CHD risk equivalent per se, such as in cases of a diabetes du-ration of < 10 years. The identification of an individual patient at particularly high risk for imminent cardiovascular and cerebrovascular events remains a challenging task in the setting of primary prevention [4]. In addition, the perceived CV-risk of the individual patient might necessitate the need for lipid-lowering therapy [5].…”

Antidiabetic effect of chitosan oligosaccharide (GO2KA1) is mediated via inhibition of intestinal alpha‐glucosidase and glucose transporters and PPARγ expression

“…Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with alterations in carbohydrate and fat metabolism and is strongly associated with major health complications, increasing overall morbidity and mortality with enormous economic costs . Although the exact etiology of T2DM remains unclear, hyperglycemia has been identified as a hallmark for T2DM and has been linked to increase the risk of major health complications .…”