Development and validation of a risk score model for prediction of lower extremity arterial disease in Chinese with type 2 diabetes aged over 50 years

Background Lower extremity arterial disease (LEAD) is highly prevalent in people with diabetes in China, but half of cases are underdiagnosed due to diversities of clinical presentations and complexities of diagnosis approaches. The purpose of this study was to develop a risk score model for LEAD to facilitate early screening among type 2 diabetes (T2DM) patients. Methods A total of 8313 participants with T2DM from the China DIA-LEAD study, a multicenter, cross-sectional epidemiological study, were selected as the training dataset to develop a risk score model for LEAD by logistic regression. The area under receiver operating characteristic curve (AUC) and bootstrapping were utilized for internal validation. A dataset of 287 participants consecutively enrolled from a teaching hospital between July 2017 and November 2017 was used as external validation for the risk score model. Results A total of 931 (11.2%) participants were diagnosed as LEAD in the training dataset. Factors including age, current smoking, duration of diabetes, blood pressure control, low density lipoprotein cholesterol, estimated glomerular filtration rate, and coexistence of cardio and/or cerebrovascular disease correlated with LEAD in logistic regression analysis and resulted in a weighed risk score model of 0–13. A score of ≥5 was found to be the optimal cut-off for discriminating moderate–high risk participants with AUC of 0.786 (95% CI: 0.778–0.795). The bootstrapping validation showed that the AUC was 0.784. Similar performance of the risk score model was observed in the validation dataset with AUC of 0.731 (95% CI: 0.651–0.811). The prevalence of LEAD was 3.4, 12.1, and 27.6% in the low risk (total score 0–4), moderate risk (total score 5–8), and high risk (total score 9–13) groups of LEAD in the training dataset, respectively, which were 4.3, 19.6, and 30.2% in the validation dataset. Conclusion The weighed risk score model for LEAD could reliably discriminate the presence of LEAD in Chinese with T2DM aged over 50 years, which may be helpful for a precise risk assessment and early diagnosis of LEAD.

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Comparison of IDRS and ADA Diabetes Risk Assessment Tools Reveals Different Rsk Score in Same Population: A Cross-Sectional Analysis in a Tertiary Care Hospital

Journal of Diabetes and Endocrine Association of Nepal ◽

10.3126/jdean.v5i1.38799 ◽

2021 ◽

Vol 5 (1) ◽

pp. 10-18

Author(s):

N. Akter ◽

N.K. Qureshi

Keyword(s):

Type 2 Diabetes ◽

Risk Assessment ◽

High Risk ◽

Risk Score ◽

Diabetes Risk ◽

Assessment Tools ◽

Cross Sectional ◽

Risk Assessment Tools ◽

Predicted Risk

Background: To identify individuals at high risk of developing type2 diabetes (T2DM), use of a validated risk-assessment tool is currently recommended. Nevertheless, recent studies have shown that risk scores that are developed in the same country can lead to different results of an individual. The Objective of study was to reveal whether two different risk-assessment tools predict similar or dissimilar high-risk score in same population. Method: This cross-sectional analytical study was carried upon 336 non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, Bangladesh from October 2018 to March 2019. Woman having previous history of Gestational Diabetes Mellitus (GDM) were also included. Both the Indian Diabetes risk Score (IDRS) and the American Diabetes (ADA) Risk Score questionnaire were used to collect the data on demographic and clinical characteristics, different risk factors of an individual subject, and to calculate predicted risk score for developing T2DM. Results: Among 336 subjects, 53.6% were female. The mean (±SD) age of the study subjects was 38.25±1.12 years. The average IDRS predicted risk score of developing T2DM was more in female subjects than male [p<0.05]. Whereas the ADA predicted increased risk score of developing type 2 diabetes was more in male subjects than female (p<0.05). IDRS categorized 37.2 % of individuals at high risk for developing diabetes; [p=0.10], while the ADA risk tool categorized 20.2% subjects in high risk group; [p<0.001]. Conclusions: The results indicate that risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent T2DM, risk scoring systems must be validated for each population considered.

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Development of a hypoglycaemia risk score to identify high‐risk individuals with advanced type 2 diabetes in DEVOTE

Diabetes Obesity and Metabolism ◽

10.1111/dom.14208 ◽

2020 ◽

Vol 22 (12) ◽

pp. 2248-2256

Author(s):

Simon Heller ◽

Ildiko Lingvay ◽

Steven P. Marso ◽

Athena Philis‐Tsimikas ◽

Thomas R. Pieber ◽

...

Keyword(s):

Type 2 Diabetes ◽

High Risk ◽

Risk Score

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A non-exercise method to determine cardiorespiratory fitness identifies females predicted to be at ‘high risk’ of type 2 diabetes

Diabetes and Vascular Disease Research ◽

10.1177/1479164116666476 ◽

2016 ◽

Vol 14 (1) ◽

pp. 47-54 ◽

Cited By ~ 2

Author(s):

Benjamin J Gray ◽

Jeffrey W Stephens ◽

Daniel Turner ◽

Michael Thomas ◽

Sally P Williams ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

Risk Score ◽

Exercise Testing ◽

Diabetes Risk ◽

Testing Method ◽

Metabolic Equivalents

This study examined the relationship between cardiorespiratory fitness determined by a non-exercise testing method for estimating fitness and predicted risk of developing type 2 diabetes mellitus using five risk assessments/questionnaires (Leicester Diabetes Risk Score, QDiabetes, Cambridge Risk Score, Finnish Diabetes Risk Score and American Diabetes Association Diabetes Risk Test). Retrospective analysis was performed on 330 female individuals with no prior diagnosis of cardiovascular disease or type 2 diabetes mellitus who participated in the Prosiect Sir Gâr workplace initiative in Carmarthenshire, South Wales. Non-exercise testing method for estimating fitness (expressed as metabolic equivalents) was calculated using a validated algorithm, and females were grouped accordingly into fitness quintiles <6.8 metabolic equivalents (Quintile 1), 6.8–7.6 metabolic equivalents (Quintile 2), 7.6–8.6 metabolic equivalents (Quintile 3), 8.6–9.5 metabolic equivalents (Quintile 4), >9.5 metabolic equivalents (Quintile 5). Body mass index, waist circumference, and HbA1c all decreased between increasing non-exercise testing method for estimating fitness quintiles ( p < 0.05), as did risk prediction scores in each of the five assessments/questionnaires ( p < 0.05). The proportion of females in Quintile 1 predicted at ‘high risk’ was between 20.9% and 81.4%, depending on diabetes risk assessment used, compared to none of the females in Quintile 5. A calculated non-exercise testing method for estimating fitness <6.8 metabolic equivalents could help to identify females at ‘high risk’ of developing type 2 diabetes mellitus as predicted using five risk assessments/questionnaires.

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Diabetes risk score in the United Arab Emirates: a screening tool for the early detection of type 2 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2017-000489 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000489 ◽

Cited By ~ 15

Author(s):

Nabil Sulaiman ◽

Ibrahim Mahmoud ◽

Amal Hussein ◽

Salah Elbadawi ◽

Salah Abusnana ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

United Arab Emirates ◽

Risk Score ◽

Family History Of Diabetes ◽

Non Invasive

ObjectiveThe objective of this study was to develop a simple non-invasive risk score, specific to the United Arab Emirates (UAE) citizens, to identify individuals at increased risk of having undiagnosed type 2 diabetes mellitus.Research design and methodsA retrospective analysis of the UAE National Diabetes and Lifestyle data was conducted. The data included demographic and anthropometric measurements, and fasting blood glucose. Univariate analyses were used to identify the risk factors for diabetes. The risk score was developed for UAE citizens using a stepwise forward regression model.ResultsA total of 872 UAE citizens were studied. The overall prevalence of diabetes in the UAE adult citizens in the Northern Emirates was 25.1%. The significant risk factors identified for diabetes were age (≥35 years), a family history of diabetes mellitus, hypertension, body mass index ≥30.0 and waist-to-hip ratio ≥0.90 for males and ≥0.85 for females. The performance of the model was moderate in terms of sensitivity (75.4%, 95% CI 68.3 to 81.7) and specificity (70%, 95% CI 65.8 to 73.9). The area under the receiver-operator characteristic curve was 0.82 (95% CI 0.78 to 0.86).ConclusionsA simple, non-invasive risk score model was developed to help to identify those at high risk of having diabetes among UAE citizens. This score could contribute to the efficient and less expensive earlier detection of diabetes in this high-risk population.

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HbA1c-Based Score Model for Predicting Death Risk in Patients with Hepatocellular Carcinoma and Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2017/3819502 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Lingling He ◽

Shuan Zhang ◽

Xiaoli Liu ◽

Yuyong Jiang ◽

Xianbo Wang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Death Risk ◽

Score Model

Aim. To establish a new score model to predict risk of death in patients with hepatocellular carcinoma and type 2 diabetes mellitus.Methods. This was a retrospective study of 147 patients with hepatocellular carcinoma and type 2 diabetes mellitus who came to Beijing Ditan Hospital between October 2008 and June 2013. Univariate and multivariate logistic regression analysis was performed to obtain the independent factors associated with death risk. A new score model was devised according to these factors.Results. A prediction score model composed of HbA1c, NLR, age, and CTP class was devised, which ranged from 0 to 7. AUROC of the score was 0.853 (P<0.001, 95% CI: 0.791–0.915). Scores 0–2, 3-4, and 5–7 identified patients as low-, medium-, and high-risk categories. The cumulative survival rate was 93.6%, 83.0%, and 74.5% in the low-risk group in 1, 2, and 3 years, while it was 64.0%, 46.0%, and 26.0% in the medium-risk group, whereas it was 24.0%, 12.0%, and 6.0% in the high-risk group, respectively. The cumulative survival rate was significantly higher in the low-risk group than that in the medium-risk group and high-risk group (P<0.001).Conclusion. The HbA1c-based score model can be used to predict death risk in patients with hepatocellular carcinoma and type 2 diabetes mellitus.

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The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

Health Technology Assessment ◽

10.3310/hta19330 ◽

2015 ◽

Vol 19 (33) ◽

pp. 1-80 ◽

Cited By ~ 15

Author(s):

Mike Gillett ◽

Alan Brennan ◽

Penny Watson ◽

Kamlesh Khunti ◽

Melanie Davies ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

High Risk ◽

Risk Score ◽

Cost Effective ◽

Data Set ◽

Uptake Rates ◽

Multiethnic Population ◽

The Cost

BackgroundAn estimated 850,000 people have diabetes without knowing it and as many as 7 million more are at high risk of developing it. Within the NHS Health Checks programme, blood glucose testing can be undertaken using a fasting plasma glucose (FPG) or a glycated haemoglobin (HbA1c) test but the relative cost-effectiveness of these is unknown.ObjectivesTo estimate and compare the cost-effectiveness of screening for type 2 diabetes using a HbA1ctest versus a FPG test. In addition, to compare the use of a random capillary glucose (RCG) test versus a non-invasive risk score to prioritise individuals who should undertake a HbA1cor FPG test.DesignCost-effectiveness analysis using the Sheffield Type 2 Diabetes Model to model lifetime incidence of complications, costs and health benefits of screening.SettingEngland; population in the 40–74-years age range eligible for a NHS health check.Data sourcesThe Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) data set was used to analyse prevalence and screening outcomes for a multiethnic population. Alternative prevalence rates were obtained from the literature or through personal communication.Methods(1) Modelling of screening pathways to determine the cost per case detected followed by long-term modelling of glucose progression and complications associated with hyperglycaemia; and (2) calculation of the costs and health-related quality of life arising from complications and calculation of overall cost per quality-adjusted life-year (QALY), net monetary benefit and the likelihood of cost-effectiveness.ResultsBased on the LEADER data set from a multiethnic population, the results indicate that screening using a HbA1ctest is more cost-effective than using a FPG. For National Institute for Health and Care Excellence (NICE)-recommended screening strategies, HbA1cleads to a cost saving of £12 and a QALY gain of 0.0220 per person when a risk score is used as a prescreen. With no prescreen, the cost saving is £30 with a QALY gain of 0.0224. Probabilistic sensitivity analysis indicates that the likelihood of HbA1cbeing more cost-effective than FPG is 98% and 95% with and without a risk score, respectively. One-way sensitivity analyses indicate that the results based on prevalence in the LEADER data set are insensitive to a variety of alternative assumptions. However, where a region of the country has a very different joint HbA1cand FPG distribution from the LEADER data set such that a FPG test yields a much higher prevalence of high-risk cases relative to HbA1c, FPG may be more cost-effective. The degree to which the FPG-based prevalence would have to be higher depends very much on the uncertain relative uptake rates of the two tests. Using a risk score such as the Leicester Practice Database Score (LPDS) appears to be more cost-effective than using a RCG test to identify individuals with the highest risk of diabetes who should undergo blood testing.LimitationsWe did not include rescreening because there was an absence of required relevant evidence.ConclusionsBased on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1ctest than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1cthan in the LEADER cohort. In such cases, whether or not it still holds that HbA1cis likely to be more cost-effective than FPG depends on the relative uptake rates for HbA1cand FPG. Use of the LPDS appears to be more cost-effective than a RCG test for prescreening.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Association of serum Cyr61 levels with peripheral arterial disease in subjects with type 2 diabetes

10.21203/rs.3.rs-62840/v2 ◽

2020 ◽

Author(s):

Feng Bin ◽

Guidong Xu ◽

Kangyun Sun ◽

Kaipeng Duan ◽

Bimin Shi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Logistic Regression ◽

Arterial Disease ◽

Logistic Regression Models ◽

Patients With Diabetes ◽

Clinically Significant ◽

Artery Disease ◽

Peripheral Arterial ◽

Fontaine Classification

Abstract Background: The prevalence of peripheral artery disease (PAD) is obviously increased in patients with diabetes. Existing evidence shows that cysteine-rich angiogenic inducer 61 (Cyr61), a 40-kD secreted protein, plays important roles in regulating cellular physiological processes. Recent studies have demonstrated a significant correlation between serum Cyr61 and atherosclerosis. However, the relationship between Cyr61 levels and PAD in patients with type 2 diabetes (T2DM) remains obscure.Methods:. Data from a total of 306 subjects with T2DM were cross-sectionally analysed. The extent of PAD was determined by using the Fontaine classification, which defines four stages. We measured serum Cyr61 concentrations by ELISA in subjects with and without PAD at Fontaine’s stage II, III, or IV. Logistic regression models were used to examine the independent association of Cyr61 with PAD.Results: Out of the 306 subjects enrolled, 150 were free from PAD, while 156 had clinically significant PAD. In subjects with PAD, the prevalences of Fontaine classification stages II, III and IV were 48.7%, 32.1%, and 19.2%, respectively. Patients with more advanced PAD had significantly higher Cyr61 (P for trend < 0.001). The prevalence of PAD on the basis of severity increased with increasing Cyr61 quartiles (all P values for trends < 0.001), and the severity of PAD was positively correlated with Cyr61 quartiles (r = 0.227, P = 0.006). The association of Cyr61 levels with PAD remained after adjusting for major risk factors in a logistic regression analysis.Conclusions: Our results demonstrated that Cyr61 was significantly increased in PAD patients with T2DM and that Cyr61 levels were positively associated with disease severity. Cyr61 could be a promising biomarker and further studies are needed to assess its clinical utility.

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A cross-sectional study to assess diabetic risk using Indian diabetic risk score among the urban population of Perambalur, South India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20211995 ◽

2021 ◽

Vol 8 (6) ◽

pp. 2923

Author(s):

Tamilarasan M. ◽

Maniprabhu Selvaraju ◽

Karthikeyan Kulothungan ◽

Srirangathan T.

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

Risk Score ◽

Urban Population ◽

Cross Sectional Study ◽

Cross Sectional ◽

Medical College

Background: Various studies from the urban population shows people are more susceptible to develop type 2 diabetes mellitus. Since the cause of diabetes is multifactorial it is necessary to screen the population to identify high-risk individuals. The objective of the study was to estimate the risk of developing type 2 Diabetes Mellitus (T2DM) using the Indian diabetes risk score (IDRS) and its determinants in the urban field practicing area of the medical college in Perambalur district.Methods: A cross-sectional study was conducted in an urban field practicing area of Dhanalakshmi Srinivasan Medical College and Hospital in Perambalur district. 400 participants of age more than 20 years enrolled in this study. IDRS risk score and data on other risk factors were obtained for every individual. Data entry was done in Excel and statistical analysis was done with SPSS version 16.Results: In our study, the proportion of male and female were almost equal. One-third of the participants 124 (31%) had a high risk of developing type 2 diabetes mellitus. Similarly, half of them 188 (47%) were at moderate risk and 88 (22%) had a low risk for diabetes. Statistically, a significant association was seen between high risk for T2DM and increased age, positive family history, Low socioeconomic status, living as a nuclear family, habits of smoking/Alcohol, and sedentary lifestyle.Conclusions: The risk of developing type 2 diabetes mellitus among the urban population is rising trends. For effective screening of the general population, IDRS can be used.

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Risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease in China

10.21203/rs.3.rs-35098/v1 ◽

2020 ◽

Author(s):

Sanbao Chai ◽

Xiaomei Zhang ◽

Ning Yuan ◽

Yufang Liu ◽

Sixu Xin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Lower Extremity ◽

Arterial Disease ◽

Disease Group ◽

Lower Extremity Arterial Disease ◽

Depressive Patients

Abstract BackgroundWe aimed to evaluate the prevalence and risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease. Methods: Four hundred and forty-one patients with type 2 diabetes mellitus were recruited from Peking University of International Hospital. All patients completed the Self-rating Depression Scale, which includes 20 items, using a 4-point scale. Univariable and multivariable logistic regression was conducted to investigate risk factors of depression in patients with lower extremity arterial disease. Results: The prevalence of depression in lower extremity arterial disease group was significantly higher than that in non- lower extremity arterial disease group(25% vs 16%, P = 0.018). In lower extremity arterial disease group(n = 215), depression score(46.18 ± 7.38 vs 44.03 ± 6.53, P = 0.003) significantly increased compared with non lower extremity arterial disease group(n = 226). Compared with male depressive patients, the proportion of female depressive patients(38% vs 15%, P = 0.003) was significantly higher in lower extremity arterial disease group. The depression score of female depressive patients(57.83 ± 3.29 vs 55.26 ± 1.59, P = 0.003) was significantly higher than that of male depressive patients. An increased risk of depression in female patients(crude OR: 2.50, 95% CI: 1.38–4.54, P = 0.003; adjusted OR: 2.34, 95% CI: 1.26–4.36, P = 0.008) and in patients with low body mass index(crude OR: 0.88, 95% CI: 0.80–0.96, P = 0.005; adjusted OR: 0.89, 95% CI: 0.81–0.97, P = 0.011) was detected. Conclusion: Both low body mass index and female are risk factors for depression.

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