New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) presents a new model for predicting which patients with type 1 diabetes will go on to develop major complications, through easily and routinely measured risk factors. The research is by Assistant Professor Sabita Soedamah-Muthu, Wageningen University, Netherlands, and colleagues.
To create the model, data were analysed from 1,973 participants with type 1 diabetes followed for seven years in the EURODIAB Prospective Complications Study, and strong prognostic factors of major outcomes were combined into a computer model. The outcomes considered to be major comprised severe coronary heart disease, stroke, end-stage renal failure, amputations, blindness and all-cause mortality. 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors for major outcomes were age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio and HDL- (good) cholesterol.
The model performance was tested in three different prospective cohorts: The Pittsburgh Epidemiology of Diabetes Complications study (EDC, USA, n=554), the Finnish Diabetic Nephropathy study (FinnDiane, Finland, n=2,999) and the Coronary Artery Calcification in Type 1 Diabetes study (CACTI, USA, n=580). After correction for systematic differences between predicted and observed risk of major outcomes in some cohorts, the model was able to accurately predict the patients' risk. "The model is pretty well able to distinguish patients who will develop major outcomes from patients who will not develop the outcomes," say the authors. "After collecting information about the patients' age, glycated haemoglobin, waist-hip ratio, albumin-creatinine ratio and HDL cholesterol health care professionals can enter this information into the provided score chart and it will automatically work out the 3, 5 and 7 year absolute risks of major outcomes in patients with type 1 diabetes."
They add: "Absolute risk predictions in individual patients with type 1 diabetes are important to timely identify the patients at high risk of major outcomes in order to enable strategies to prevent the development of such complications and to reduce health care costs. Further, prognostic models have an important role in informing the patient and to select high-risk populations for randomised controlled trials (RCTs)."
The authors highlight that the model can be used to help patients at high risk by treating all modifiable risk factors. "Predicting major outcomes permits establishment of a risk profile for individual patients with type 1 diabetes," they say. "Physicians may consider active intervention in the identified high risk patients. Such interventions can include intensifying insulin regimen and cardiovascular risk management following existing guidelines. In more detail, these findings will help to identify those at greatest risk and thus help to focus the intervention. Examples of such interventions are insulin, oral glucose lowering agents, ACE inhibitors, angiotensin receptor blockers, statins, diet and lifestyle management."
They conclude: "A prognostic model is now available to assess the absolute risk of major outcomes in patients with type 1 diabetes. The prognostic model may be useful for providing individual risk estimates of major outcomes. The risk estimates can guide surveillance recommendations, inform patients and allow efficient design and analysis of clinical trials."
- Trevor J. Orchard et al. Predicting major outcomes in type 1 diabetes: a model development and validation study. Diabetologia, August 2014 DOI: 10.1007/s00125-014-3358-x
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