Diabetes Res Clin Pract. 2014 Mar 28. pii: S0168-8227(14)00169-7. doi: 10.1016/j.diabres.2014.03.013. [Epub ahead of print]
Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study.
Mühlenbruch K1, Ludwig T2, Jeppesen C1, Joost HG3, Rathmann W4, Meisinger C2, Peters A2, Boeing H5, Thorand B2, Schulze MB6.
Several published diabetes prediction models include information about family history of diabetes. The aim of this study was to extend the previously developed German Diabetes Risk Score (GDRS) with family history of diabetes and to validate the updated GDRS in the Multinational MONItoring of trends and determinants in CArdiovascular Diseases (MONICA)/German Cooperative Health Research in the Region of Augsburg (KORA) study.
We used data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study for extending the GDRS, including 21,846 participants. Within 5 years of follow-up 492 participants developed diabetes. The definition of family history included information about the father, the mother and/or sibling/s. Model extension was evaluated by discrimination and reclassification. We updated the calculation of the score and absolute risks. External validation was performed in the MONICA/KORA study comprising 11,940 participants with 315 incident cases after 5 years of follow-up.
The basic ROC-AUC of 0.856 (95%-CI: 0.842-0.870) was improved by 0.007 (0.003-0.011) when parent and sibling history was included in the GDRS. The net reclassification improvement was 0.110 (0.072-0.149), respectively. For the updated score we demonstrated good calibration across all tenths of risk. In MONICA/KORA, the ROC-AUC was 0.837 (0.819-0.855); regarding calibration we saw slight overestimation of absolute risks.
Inclusion of the number of diabetes-affected parents and sibling history improved the prediction of type 2 diabetes. Therefore, we updated the GDRS algorithm accordingly. Validation in another German cohort study showed good discrimination and acceptable calibration for the vast majority of individuals.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Receiver operating characteristic, Reclassification, Risk assessment, Type 2 Diabetes mellitus, Validation study
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