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. 2011 Feb;54(2):264-70.
doi: 10.1007/s00125-010-1960-0. Epub 2010 Nov 14.

External validation of the UK Prospective Diabetes Study (UKPDS) risk engine in patients with type 2 diabetes

S van Dieren  1 , L M Peelen, U Nöthlings, Y T van der Schouw, G E H M Rutten, A M W Spijkerman, D L van der A, D Sluik, H Boeing, K G M Moons, J W J Beulens
Affiliations

External validation of the UK Prospective Diabetes Study (UKPDS) risk engine in patients with type 2 diabetes

S van Dieren et al. Diabetologia. 2011 Feb.

Abstract

Aims/hypothesis: Treatment guidelines recommend the UK Prospective Diabetes Study (UKPDS) risk engine for predicting cardiovascular risk in patients with type 2 diabetes, although validation studies showed moderate performance. The methods used in these validation studies were diverse, however, and sometimes insufficient. Hence, we assessed the discrimination and calibration of the UKPDS risk engine to predict 4, 5, 6 and 8 year cardiovascular risk in patients with type 2 diabetes.

Methods: The cohort included 1,622 patients with type 2 diabetes. During a mean follow-up of 8 years, patients were followed for incidence of CHD and cardiovascular disease (CVD). Discrimination and calibration were assessed for 4, 5, 6 and 8 year risk. Discrimination was examined using the c-statistic and calibration by visually inspecting calibration plots and calculating the Hosmer-Lemeshow χ(2) statistic.

Results: The UKPDS risk engine showed moderate to poor discrimination for both CHD and CVD (c-statistic of 0.66 for both 5 year CHD and CVD risks), and an overestimation of the risk (224% and 112%). The calibration of the UKPDS risk engine was slightly better for patients with type 2 diabetes who had been diagnosed with diabetes more than 10 years ago compared with patients diagnosed more recently, particularly for 4 and 5 year predicted CVD and CHD risks. Discrimination for these periods was still moderate to poor.

Conclusions/interpretation: We observed that the UKPDS risk engine overestimates CHD and CVD risk. The discriminative ability of this model is moderate, irrespective of various subgroup analyses. To enhance the prediction of CVD in patients with type 2 diabetes, this model should be updated.

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Figures

Fig. 1
Fig. 1
Calibration plots for 5 year calculated risk for (a) CHD and (b) CVD. Values depict observed and predicted values with 95% CI. The dotted 45° line denotes ideal agreement between predicted and observed risk. Results based on first analysis (censored cases excluded)
See this image and copyright information in PMC

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