title: Validation of a nomogram for predicting regression from impaired fasting glucose to normoglycaemia to facilitate clinical decision making.
abstract: In Hong Kong, fasting plasma glucose (FPG) is the most popular screening test for diabetes mellitus (DM) in primary care. Individuals with impaired fasting glucose (IFG) are commonly encountered.
  
  
  
  To explore the determinants of regression to normoglycaemia among primary care patients with IFG based on non-invasive variables and to establish a nomogram for the prediction of regression from IFG.
  
  
  
  This cohort study consisted of 1197 primary care patients with IFG. These subjects were invited to repeat a FPG test and 75-g 2-hour oral glucose tolerance test (2h-OGTT) to determine the glycaemia change. Normoglycaemia was defined as FPG <5.6 mmol/L and 2h-OGTT <7.8 mmol/L. Stepwise logistic regression model was developed to predict the regression to normoglycaemia with non-invasive variables, using a randomly selected training dataset (810 subjects). The model was validated on the remaining testing dataset (387 subjects). Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test were used to evaluate discrimination and calibration of the model. A nomogram was constructed based on the model.
  
  
  
  After a mean follow-up period of 6.1 months, 180 subjects (15.0%) had normoglycaemia based on the repeated FPG and 2h-OGTT results at follow-up. Subjects without central obesity or hypertension, with moderate-to-high-level physical activity and a lower baseline FPG level, were more likely to regress to normoglycaemia. The prediction model had acceptable discrimination (AUC = 0.705) and calibration (P = 0.840).
  
  
  
  The simple-to-use nomogram could facilitate identification of subjects with low risk of progression to DM and thus aid in clinical decision making and resource prioritization in the primary care setting.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Hong Kong.
authors.forename: Vivian Yw
authors.initials: VY
authors.lastname: Guo
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Hong Kong, ytyu@hku.hk.
authors.forename: Esther Yt
authors.initials: EY
authors.lastname: Yu
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Hong Kong.
authors.forename: Carlos Kh
authors.initials: CKh
authors.lastname: Wong
authors.affiliation: Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin Hong Kong and.
authors.forename: Regina Ws
authors.initials: RW
authors.lastname: Sit
authors.affiliation: Department of Family Medicine and Primary Health Care, Hong Kong West Cluster, Hospital Authority, Hong Kong.
authors.forename: Jenny Hl
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Hong Kong.
authors.forename: S Y
authors.initials: SY
authors.lastname: Ho
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Hong Kong.
authors.forename: Cindy Lk
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D000066491:Clinical Decision-Making / Q000379:methods*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006723:Hong Kong; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011320:Primary Health Care; D012372:ROC Curve
chemical_list: D001786:Blood Glucose
keywords: Chinese; impaired fasting glucose; nomogram; normoglycaemia; primary care; regression.