title: Progression to microalbuminuria in type 1 diabetes: development and validation of a prediction rule.
abstract: OBJECTIVE
  Microalbuminuria is common in type 1 diabetes and is associated with an increased risk of renal and cardiovascular disease. We aimed to develop and validate a clinical prediction rule that estimates the absolute risk of microalbuminuria.
  
  
  METHODS
  Data from the European Diabetes Prospective Complications Study (n = 1115) were used to develop the prediction rule (development set). Multivariable logistic regression analysis was used to assess the association between potential predictors and progression to microalbuminuria within 7 years. The performance of the prediction rule was assessed with calibration and discrimination (concordance statistic [c-statistic]) measures. The rule was validated in three other diabetes studies (Pittsburgh Epidemiology of Diabetes Complications [EDC] study, Finnish Diabetic Nephropathy [FinnDiane] study and Coronary Artery Calcification in Type 1 Diabetes [CACTI] study).
  
  
  RESULTS
  Of patients in the development set, 13% were microalbuminuric after 7 years. Glycosylated haemoglobin, AER, WHR, BMI and ever smoking were found to be the most important predictors. A high-risk group (n = 87 [8%]) was identified with a risk of progression to microalbuminuria of 32%. Predictions showed reasonable discriminative ability, with c-statistic of 0.71. The rule showed good calibration and discrimination in EDC, FinnDiane and CACTI (c-statistic 0.71, 0.79 and 0.79, respectively).
  
  
  CONCLUSIONS
  We developed and validated a clinical prediction rule that uses relatively easily obtainable patient characteristics to predict microalbuminuria in patients with type 1 diabetes. This rule can help clinicians to decide on more frequent check-ups for patients at high risk of microalbuminuria in order to prevent long-term chronic complications.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Str 6.131, PO Box 85500, 3508 GA, Utrecht, the Netherlands. y.vergouwe@umcutrecht.nl
authors.forename: Y
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: S S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.forename: J
authors.initials: J
authors.lastname: Zgibor
authors.forename: N
authors.initials: N
authors.lastname: Chaturvedi
authors.forename: C
authors.initials: C
authors.lastname: Forsblom
authors.forename: J K
authors.initials: JK
authors.lastname: Snell-Bergeon
authors.forename: D M
authors.initials: DM
authors.lastname: Maahs
authors.forename: P-H
authors.initials: PH
authors.lastname: Groop
authors.forename: M
authors.initials: M
authors.lastname: Rewers
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: J H
authors.initials: JH
authors.lastname: Fuller
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D056808:Biostatistics / Q000379:methods; D001794:Blood Pressure; D015992:Body Mass Index; D002138:Calibration; D048909:Diabetes Complications / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000652:urine; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D018450:Disease Progression; D005060:Europe; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D049629:Waist-Hip Ratio