title: Non-invasive risk scores for prediction of type 2 diabetes (EPIC-InterAct): a validation of existing models.
abstract: BACKGROUND
  The comparative performance of existing models for prediction of type 2 diabetes across populations has not been investigated. We validated existing non-laboratory-based models and assessed variability in predictive performance in European populations.
  
  
  METHODS
  We selected non-invasive prediction models for incident diabetes developed in populations of European ancestry and validated them using data from the EPIC-InterAct case-cohort sample (27,779 individuals from eight European countries, of whom 12,403 had incident diabetes). We assessed model discrimination and calibration for the first 10 years of follow-up. The models were first adjusted to the country-specific diabetes incidence. We did the main analyses for each country and for subgroups defined by sex, age (<60 years vs ≥60 years), BMI (<25 kg/m(2)vs ≥25 kg/m(2)), and waist circumference (men <102 cm vs ≥102 cm; women <88 cm vs ≥88 cm).
  
  
  RESULTS
  We validated 12 prediction models. Discrimination was acceptable to good: C statistics ranged from 0·76 (95% CI 0·72-0·80) to 0·81 (0·77-0·84) overall, from 0·73 (0·70-0·76) to 0·79 (0·74-0·83) in men, and from 0·78 (0·74-0·82) to 0·81 (0·80-0·82) in women. We noted significant heterogeneity in discrimination (pheterogeneity<0·0001) in all but one model. Calibration was good for most models, and consistent across countries (pheterogeneity>0·05) except for three models. However, two models overestimated risk, DPoRT by 34% (95% CI 29-39%) and Cambridge by 40% (28-52%). Discrimination was always better in individuals younger than 60 years or with a low waist circumference than in those aged at least 60 years or with a large waist circumference. Patterns were inconsistent for BMI. All models overestimated risks for individuals with a BMI of <25 kg/m(2). Calibration patterns were inconsistent for age and waist-circumference subgroups.
  
  
  CONCLUSIONS
  Existing diabetes prediction models can be used to identify individuals at high risk of type 2 diabetes in the general population. However, the performance of each model varies with country, age, sex, and adiposity.
  
  
  BACKGROUND
  The European Union.
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands; University of Cape Town and South African Medical Research Council, Cape Town, South Africa; The George Institute for Global Health, Sydney, NSW, Australia.
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authors.initials: AP
authors.lastname: Kengne
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: j.beulens@umcutrecht.nl.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Linda M
authors.initials: LM
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authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Karel G M
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authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: German Institute of Nutrition, Potsdam-Rehbruecke, Germany.
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Simon J
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authors.lastname: Griffin
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Luigi
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authors.lastname: Palla
authors.affiliation: Murcia Regional Health Council, Murcia, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Tormo
authors.affiliation: Public Health Division of Gipuzkoa, San Sebastian, Spain.
authors.forename: Larraitz
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authors.lastname: Arriola
authors.affiliation: Hjelt Institute, University of Helsinki, Helsinki, Finland.
authors.forename: Noël C
authors.initials: NC
authors.lastname: Barengo
authors.affiliation: Navarre Public Health Institute, Pamplona, Spain.
authors.forename: Aurelio
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authors.lastname: Barricarte
authors.affiliation: German Institute of Nutrition, Potsdam-Rehbruecke, Germany.
authors.forename: Heiner
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authors.lastname: Boeing
authors.affiliation: Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Catalina
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authors.lastname: Bonet
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Villejuif, France.
authors.forename: Françoise
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authors.lastname: Clavel-Chapelon
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Villejuif, France.
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authors.lastname: Dartois
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Villejuif, France.
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authors.lastname: Fagherazzi
authors.affiliation: Lund University, Malmö, Sweden.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.affiliation: Murcia Regional Health Council, Murcia, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Rudolf
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authors.lastname: Kaaks
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Kay Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: German Cancer Research Centre, Heidelberg, Germany.
authors.forename: Kuanrong
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authors.lastname: Li
authors.affiliation: German Institute of Nutrition, Potsdam-Rehbruecke, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mühlenbruch
authors.affiliation: Lund University, Malmö, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Thure F
authors.initials: TF
authors.lastname: Overvad
authors.affiliation: Cancer Research and Prevention Institute, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Federico II University, Naples, Italy.
authors.forename: Salvatore
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authors.lastname: Panico
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: Umeå University, Umeå, Sweden.
authors.forename: Olov
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authors.lastname: Rolandsson
authors.affiliation: Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Nina
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authors.lastname: Roswall
authors.affiliation: Center for Cancer Prevention, Turin, Italy.
authors.forename: Carlotta
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authors.lastname: Sacerdote
authors.affiliation: Andalusian School of Public Health, Granada, Spain.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Nadia
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authors.lastname: Slimani
authors.affiliation: Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Tagliabue
authors.affiliation: Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Anne
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authors.lastname: Tjønneland
authors.affiliation: Cancer Registry and Histopathology Unit, Azienda Sanitaria Provinciale 7, Ragusa, Italy.
authors.forename: Rosario
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authors.lastname: Tumino
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Nita G
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authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Stephen J
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authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
authors.forename: Claudia
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authors.lastname: Langenberg
authors.affiliation: Imperial College London, London, UK.
authors.forename: Elio
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authors.affiliation: Medical Research Council Epidemiology Unit, Cambridge, UK.
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mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D055105:Waist Circumference; D044465:White People