Azienda Ospedaliera Città della Salute e della Scienza and University of Turin, Turin, Italy.
Diabetologia. 2013 Aug;56(8):1726-34. doi: 10.1007/s00125-013-2933-x. Epub 2013 May 17.
AIMS/HYPOTHESIS: The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model can be used to estimate the lifetime occurrence of major diabetes-related complications in order to calculate health economic outcomes. The aim of the study was to assess the performance of the model by comparing the predicted and observed mortality and the incidence of macrovascular complications in an Italian population-based cohort with type 2 diabetes.
We used data from the Casale Monferrato Survey, a cohort enrolled in 1988 and surveyed in 1991 (n = 1,967) to assess the prevalence of cardiovascular risk factors. In 2000, a new survey included all the members of the original cohort who were still alive (n = 860), and in addition all individuals identified with a new diagnosis of type 2 diabetes since 1993 (n = 2,389). We compared the mortality predicted by the model for the 1991 survey over the subsequent 17-year period with the observed risk. The following outcomes were analysed in the 2000 survey: myocardial infarction (MI), other ischaemic heart disease, stroke, congestive heart failure (CHF) and amputation.
For all-cause mortality, the predictions from the model at 5 and 10 years (23% and 47%, respectively) were identical to the observed risks. At 15 years, the risk of death was slightly overestimated (an estimate of 67% vs 64% observed, 95% CI 61%, 66%). The performance of the model was best for patients with a recent history of disease (duration <6 years). Among the complications, the predicted cumulative incidences of MI and CHF were very close to those observed.
CONCLUSIONS/INTERPRETATION: External validation is essential to assess the accuracy of simulation models. The UKPDS Outcomes Model satisfactorily predicted a set of actual incidences of mortality and complications in an Italian diabetes cohort up to a duration of approximately 12 years. The longer term performance of such models should be carefully evaluated.
目的/假设：英国前瞻性糖尿病研究（UKPDS）结局模型可用于估计主要糖尿病相关并发症的终生发生情况，以便计算健康经济学结局。本研究的目的是通过比较意大利人群队列中预测和观察到的死亡率以及大血管并发症的发生率来评估该模型的性能，该队列患有 2 型糖尿病。
我们使用了 1988 年招募并于 1991 年进行调查的卡萨尔蒙费拉托调查（Casale Monferrato Survey）的数据，以评估心血管危险因素的患病率。2000 年，一项新的调查包括了所有仍然存活的原始队列成员（n=860），以及自 1993 年以来新诊断为 2 型糖尿病的所有个体（n=2389）。我们比较了模型对 1991 年调查在随后 17 年内的预测死亡率与观察到的风险。2000 年的调查分析了以下结局：心肌梗死（MI）、其他缺血性心脏病、中风、充血性心力衰竭（CHF）和截肢。
对于全因死亡率，模型在 5 年和 10 年时的预测（分别为 23%和 47%）与观察到的风险一致。在 15 年时，死亡风险略有高估（估计为 67%，而观察到的为 64%，95%CI 61%，66%）。该模型对近期病史（<6 年）的患者的性能最佳。在并发症中，预测的 MI 和 CHF 累积发生率与观察到的非常接近。
结论/解释：外部验证对于评估模拟模型的准确性至关重要。UKPDS 结局模型在意大利糖尿病队列中，在大约 12 年的时间内，较好地预测了一组实际死亡率和并发症发生率。应仔细评估此类模型的长期性能。
