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External validation of the KORA S4/F4 prediction models for the risk of developing type 2 diabetes in older adults: the PREVEND study

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Abstract

Recently, prediction models for type 2 diabetes mellitus (T2DM) in older adults (aged ≥55 year) were developed in the KORA S4/F4 study, Augsburg, Germany. We aimed to externally validate the KORA models in a Dutch population. We used data on both older adults (n = 2,050; aged ≥55 year) and total non-diabetic population (n = 6,317; aged 28–75 year) for this validation. We assessed performance of base model (model 1: age, sex, BMI, smoking, parental diabetes and hypertension) and two clinical models: model 1 plus fasting glucose (model 2); and model 2 plus uric acid (model 3). For 7-year risk of T2DM, we calculated C-statistic, Hosmer–Lemeshow χ2-statistic, and integrated discrimination improvement (IDI) as measures of discrimination, calibration and reclassification, respectively. After a median follow-up of 7.7 years, 199 (9.7%) and 374 (5.9%) incident cases of T2DM were ascertained in the older and total population, respectively. In the older adults, C-statistic was 0.66 for model 1. This was improved for model 2 and model 3 (C-statistic = 0.81) with significant IDI. In the total population, these respective C-statistics were 0.77, 0.85 and 0.85. All models showed poor calibration (P < 0.001). After adjustment for the intercept and slope of each model, we observed good calibration for most models in both older and total populations. We validated the KORA clinical models for prediction of T2DM in an older Dutch population, with discrimination similar to the development cohort. However, the models need to be corrected for intercept and slope to acquire good calibration for application in a different setting.

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Abbreviations

ARICA:

Atherosclerosis risk in communities

BMI:

Body mass index

DESIR:

Data from the epidemiological study on the insulin resistance syndrome

FINDRISC:

Finnish diabetes risk score

HbA1c:

Glycosylated hemoglobin

IDI:

Integrated discrimination improvement

KORA:

Cooperative health research in the region of Augsburg

PREVEND:

Prevention of renal and vascular end stage disease

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Acknowledgments

This work was supported by the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl); project PREDICCt (grant 01C-104-07). We thank Prof. Dr. L.T.W. de Jong-van den Berg and Dr. S.T. Visser from the Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration, University Medical Center Groningen and University of Groningen, The Netherlands for providing the data on use of glucose-lowering agents according to central pharmacy registration. The Diabetes Cohort Study was funded by a German Research Foundation project grant to W. Rathmann (DFG;RA 459/2–1). The KORA research platform and the KORA Augsburg studies are financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria. We thank the field staff in Augsburg who were involved in the conduct of the studies. The German Diabetes Center is funded by the German Federal Ministry of Health and the Ministry of Innovation, Science, Research and Technology of the State of North Rhine Westphalia. None of the study sponsors had a role in study design; in data collection, analysis, or interpretation; in writing the report; or in the decision to submit for publication.

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Abbasi, A., Corpeleijn, E., Peelen, L.M. et al. External validation of the KORA S4/F4 prediction models for the risk of developing type 2 diabetes in older adults: the PREVEND study. Eur J Epidemiol 27, 47–52 (2012). https://doi.org/10.1007/s10654-011-9648-4

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