Center for Primary Care and Outcomes Research, Center for Population Health Sciences, Departments of Medicine and Health Research and Policy, Stanford University, Stanford, CA
Center for Primary Care, Harvard Medical School, Boston, MA.
Diabetes Care. 2018 Mar;41(3):586-595. doi: 10.2337/dc17-2002. Epub 2017 Dec 21.
We sought to validate Risk Equations for Complications of Type 2 Diabetes (RECODe) among diverse populations.
We compared risk predictions from RECODe equations and from two alternative risk models (UK Prospective Diabetes Study Outcomes Model 2 [UKPDS OM2] and American College of Cardiology/American Heart Association Pooled Cohort Equations) to observed outcomes in two studies: the Multi-Ethnic Study of Atherosclerosis (MESA, = 1,555 adults with type 2 diabetes, median follow-up 9.1 years) and the Jackson Heart Study (JHS, = 1,746 adults with type 2 diabetes, median follow-up 8.0 years). Outcomes included nephropathy by multiple measures (microalbuminuria, macroalbuminuria, renal failure, end-stage renal disease, and reduction in glomerular filtration rate), moderate to severe diabetic retinopathy by Airlie House classification, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, congestive heart failure, and all-cause mortality.
RECODe equations for microvascular and cardiovascular outcomes had C-statistics for discrimination ranging from 0.71 to 0.85 in MESA and 0.64 to 0.91 in JHS for alternative outcomes. Calibration slopes in MESA ranged from 0.62 for a composite nephropathy outcome, 0.83-1.04 for individual nephropathy outcomes, 1.07 for retinopathy, 1.00-1.05 for cardiovascular outcomes, and 1.03 for all-cause mortality. Slopes in JHS ranged from 0.47 for retinopathy, 0.97-1.16 for nephropathy, 0.72-1.05 for cardiovascular outcomes, and 1.01 for all-cause mortality. The alternative models had C-statistics 0.50-0.72 and calibration slopes 0.07-0.60.
RECODe equations improved risk estimation for diverse patients with type 2 diabetes, as compared with two commonly used alternatives.
我们旨在验证适用于不同人群的 2 型糖尿病并发症风险方程（RECODe）。
我们将 RECODe 方程与两种替代风险模型（英国前瞻性糖尿病研究结果模型 2（UKPDS OM2）和美国心脏病学会/美国心脏协会 pooled cohort equations）的风险预测进行比较，以观察两项研究的结果：动脉粥样硬化多民族研究（MESA，n=1555 例 2 型糖尿病患者，中位随访时间 9.1 年）和杰克逊心脏研究（JHS，n=1746 例 2 型糖尿病患者，中位随访时间 8.0 年）。结果包括多种指标的肾病（微量白蛋白尿、大量白蛋白尿、肾衰竭、终末期肾病和肾小球滤过率降低）、Airlie House 分类的中重度糖尿病视网膜病变、致命或非致命性心肌梗死、致命或非致命性卒中和充血性心力衰竭以及全因死亡率。
在 MESA 中，RECODe 方程用于微血管和心血管结局的判别 C 统计量为 0.71-0.85，在 JHS 中为 0.64-0.91。MESA 中的校准斜率范围从复合肾病结局的 0.62 到单个肾病结局的 0.83-1.04、视网膜病变的 1.07、心血管结局的 1.00-1.05 和全因死亡率的 1.03。JHS 的斜率范围从视网膜病变的 0.47、肾病的 0.97-1.16、心血管结局的 0.72-1.05 和全因死亡率的 1.01。替代模型的 C 统计量为 0.50-0.72，校准斜率为 0.07-0.60。
与两种常用的替代方案相比，RECODe 方程提高了对 2 型糖尿病患者的风险估计。
Zotero 插件