1. Progression to microalbuminuria in type 1 diabetes: development and validation of a prediction rule.
- Author
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Vergouwe Y, Soedamah-Muthu SS, Zgibor J, Chaturvedi N, Forsblom C, Snell-Bergeon JK, Maahs DM, Groop PH, Rewers M, Orchard TJ, Fuller JH, and Moons KG
- Subjects
- Adult, Biostatistics methods, Blood Pressure, Body Mass Index, Calibration, Diabetes Complications epidemiology, Diabetes Mellitus, Type 1 urine, Diabetic Angiopathies epidemiology, Diabetic Nephropathies epidemiology, Disease Progression, Europe, Female, Finland, Humans, Male, Predictive Value of Tests, Prospective Studies, Regression Analysis, Reproducibility of Results, Waist-Hip Ratio, Albuminuria epidemiology, Diabetes Mellitus, Type 1 physiopathology
- Abstract
Aims/hypothesis: Microalbuminuria is common in type 1 diabetes and is associated with an increased risk of renal and cardiovascular disease. We aimed to develop and validate a clinical prediction rule that estimates the absolute risk of microalbuminuria., Methods: Data from the European Diabetes Prospective Complications Study (n = 1115) were used to develop the prediction rule (development set). Multivariable logistic regression analysis was used to assess the association between potential predictors and progression to microalbuminuria within 7 years. The performance of the prediction rule was assessed with calibration and discrimination (concordance statistic [c-statistic]) measures. The rule was validated in three other diabetes studies (Pittsburgh Epidemiology of Diabetes Complications [EDC] study, Finnish Diabetic Nephropathy [FinnDiane] study and Coronary Artery Calcification in Type 1 Diabetes [CACTI] study)., Results: Of patients in the development set, 13% were microalbuminuric after 7 years. Glycosylated haemoglobin, AER, WHR, BMI and ever smoking were found to be the most important predictors. A high-risk group (n = 87 [8%]) was identified with a risk of progression to microalbuminuria of 32%. Predictions showed reasonable discriminative ability, with c-statistic of 0.71. The rule showed good calibration and discrimination in EDC, FinnDiane and CACTI (c-statistic 0.71, 0.79 and 0.79, respectively)., Conclusions/interpretation: We developed and validated a clinical prediction rule that uses relatively easily obtainable patient characteristics to predict microalbuminuria in patients with type 1 diabetes. This rule can help clinicians to decide on more frequent check-ups for patients at high risk of microalbuminuria in order to prevent long-term chronic complications.
- Published
- 2010
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