External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population

Abstract

Introduction: Characterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2 diabetes in the USA and model the population benefit of diabetes prevention approaches using population survey data.

Research design and methods: The Diabetes Population Risk Tool (DPoRT), originally derived and validated in Canada, was applied to an external validation cohort of 23 477 adults from the 2009 National Health Interview Survey (NHIS). We assessed predictive performance for discrimination (C-statistic) and calibration plots against observed incident diabetes cases identified from the NHIS 2009-2018 cycles. We applied DPoRT to the 2018 NHIS cohort (n=21 187) to generate 10-year risk prediction estimates and characterize the preventive benefit of three diabetes prevention scenarios: (1) community-wide strategy; (2) high-risk strategy and (3) combined approach.

Results: DPoRT demonstrated good discrimination (C-statistic=0.778 (males); 0.787 (females)) and good calibration across the range of risk. We predicted a baseline risk of 10.2% and 21 076 000 new cases of diabetes in the USA from 2018 to 2028. The community-wide strategy and high-risk strategy estimated diabetes risk reductions of 0.2% and 0.3%, respectively. The combined approach estimated a 0.4% risk reduction and 843 000 diabetes cases averted in 10 years.

Conclusions: DPoRT has transportability for predicting population-level diabetes risk in the USA using routinely collected survey data. We demonstrate the model's applicability for population health assessment and diabetes prevention planning. Our modeling predicted that the combination of community-wide and targeted prevention approaches for those at highest risk are needed to reduce diabetes burden in the USA.

Keywords: diabetes mellitus, type 2; population health; risk assessment.

Figure 1

Diabetes Population Risk Tool (DPoRT) predictive performance for the original and updated models in the US population: (A) DPoRT original (male); (B) DPoRT original (female); (C) intercept recalibration (male); (D) intercept recalibration (female); (E) logistic recalibration (male); (F) logistic recalibration (female); (G) model extension (insurance) (male); (H) model extension (insurance) (female); (I) model extension (ethnicity) (male); (J) model extension (ethnicity) (female).

Figure 2

10-Year Diabetes Population Risk Tool estimated diabetes risk and new cases (2018–2028) in the US population according to: (A) age group; (B) ethnicity; (C) body mass index (BMI).

Figure 3

Predicted diabetes risk and cases in the US population at baseline and by prevention scenario (2018–2028).