Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal; German Center for Diabetes Research (DZD), Munich; Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), Berlin; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg; Institute for Global Food Security, Queen's University Belfast, Belfast, UK; Department of Medicine IV, University Hospital Tübingen; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen; Institute of Nutritional Science, University of Potsdam, Nuthetal.
Dtsch Arztebl Int. 2022 Sep 30;119(39):651-657. doi: 10.3238/arztebl.m2022.0268.
The German Diabetes Risk Score (GDRS) currently enables prediction of the individual risk of developing type 2 diabetes (T2D) within five years. The aim of this study is to extend the prediction period of the GDRS, including its non-clinical version and its HbA1c extension, to 10 years, and to perform external validation.
In data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study (n = 25 393), Cox proportional hazards regression was used to reweight the points that were used to calculate the five-year risk. Two population-based prospective cohorts (EPIC-Heidelberg n = 23 624, GNHIES98 cohort n = 3717) were used for external validation. Discrimination was represented by C-indices, and calibration by calibration plots and the expected-to-observed (E/O) ratio.
Prediction performance in EPIC-Potsdam was very good (C-index for the non-clinical model: 0.834) and was confirmed in EPIC-Heidelberg (0.843) and in the GNHIES98 cohort (0.851). Among persons in the GNHIES98 cohort with a greater than 10% predicted probability of disease, 14.9% developed T2D within 10 years (positive predictive value). The models were very well calibrated in EPIC-Potsdam (E/O ratio for the non-clinical model: 1.08), slightly overestimated the risk in EPIC-Heidelberg (1.34), and predicted T2D very well in the GNHIES98 cohort after recalibration (1.06).
The extended GDRS prediction period of 10 years, with a non-clinical version and an HbA1c extension that will soon be available in both German and English, enables the even longer-range, evidence-based identification of high-risk individuals with many different applications, including medical screening.
德国糖尿病风险评分（GDRS）目前可用于预测个体在五年内患 2 型糖尿病（T2D）的风险。本研究旨在将 GDRS 的预测期延长至 10 年，包括其非临床版本和 HbA1c 扩展版本，并进行外部验证。
在欧洲癌症与营养前瞻性调查（EPIC）-波茨坦研究的数据（n=25393）中，使用 Cox 比例风险回归对用于计算五年风险的分数进行重新加权。两个基于人群的前瞻性队列（EPIC-Heidelberg n=23624，GNHIES98 队列 n=3717）用于外部验证。使用 C 指数表示区分度，使用校准图和期望观察（E/O）比表示校准。
在 EPIC-Potsdam 中的预测性能非常好（非临床模型的 C 指数：0.834），并在 EPIC-Heidelberg（0.843）和 GNHIES98 队列（0.851）中得到证实。在 GNHIES98 队列中，有大于 10%预测疾病概率的人群中，14.9%在 10 年内发生 T2D（阳性预测值）。模型在 EPIC-Potsdam 中非常准确（非临床模型的 E/O 比：1.08），在 EPIC-Heidelberg 中略有高估（1.34），在重新校准后在 GNHIES98 队列中很好地预测了 T2D（1.06）。
扩展的 GDRS 预测期为 10 年，具有非临床版本和即将在德英两种语言中提供的 HbA1c 扩展，可更长期、基于证据地识别具有多种不同应用的高风险个体，包括医疗筛查。
