title: Predicting macro- and microvascular complications in type 2 diabetes: the Japan Diabetes Complications Study/the Japanese Elderly Diabetes Intervention Trial risk engine.
abstract: OBJECTIVE
  To develop and validate a risk engine that calculates the risks of macro- and microvascular complications in type 2 diabetes.
  
  
  METHODS
  We analyzed pooled data from two clinical trials on 1,748 Japanese type 2 diabetic patients without diabetes complications other than mild diabetic retinopathy with a median follow-up of 7.2 years. End points were coronary heart disease (CHD), stroke, noncardiovascular mortality, overt nephropathy defined by persistent proteinuria, and progression of retinopathy. We fit a multistate Cox regression model to derive an algorithm for prediction. The predictive accuracy of the calculated 5-year risks was cross-validated.
  
  
  RESULTS
  Sex, age, HbA1c, years after diagnosis, BMI, systolic blood pressure, non-HDL cholesterol, albumin-to-creatinine ratio, atrial fibrillation, current smoker, and leisure-time physical activity were risk factors for macro- and microvascular complications and were incorporated into the risk engine. The observed-to-predicted (O/P) ratios for each event were between 0.93 and 1.08, and Hosmer-Lemeshow tests showed no significant deviations between observed and predicted events. In contrast, the UK Prospective Diabetes Study (UKPDS) risk engine overestimated CHD risk (O/P ratios: 0.30 for CHD and 0.72 for stroke). C statistics in our Japanese patients were high for CHD, noncardiovascular mortality, and overt nephropathy (0.725, 0.696, and 0.767) but moderate for stroke and progression of retinopathy (0.636 and 0.614). By combining macro- and microvascular risks, the classification of low- and high-risk patients was improved by a net reclassification improvement of 5.7% (P = 0.02).
  
  
  CONCLUSIONS
  The risk engine accurately predicts macro- and microvascular complications and would provide helpful information in risk classification and health economic simulations.
authors: Department of Clinical Trial Design and Management, Kyoto University Hospital, Kyoto, Japan.
authors: Shiro
authors: S
authors: Tanaka
authors: Sachiko
authors: S
authors: Tanaka
authors: Satoshi
authors: S
authors: Iimuro
authors: Hidetoshi
authors: H
authors: Yamashita
authors: Shigehiro
authors: S
authors: Katayama
authors: Yasuo
authors: Y
authors: Akanuma
authors: Nobuhiro
authors: N
authors: Yamada
authors: Atsushi
authors: A
authors: Araki
authors: Hideki
authors: H
authors: Ito
authors: Hirohito
authors: H
authors: Sone
authors: Yasuo
authors: Y
authors: Ohashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology
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