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Estimation of Mortality Risk in Type 2 Diabetic Patients (ENFORCE): An Inexpensive and Parsimonious Prediction Model.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2019 Oct 01; Vol. 104 (10), pp. 4900-4908. - Publication Year :
- 2019
-
Abstract
- Context: We previously developed and validated an inexpensive and parsimonious prediction model of 2-year all-cause mortality in real-life patients with type 2 diabetes.<br />Objective: This model, now named ENFORCE (EstimatioN oF mORtality risk in type 2 diabetiC patiEnts), was investigated in terms of (i) prediction performance at 6 years, a more clinically useful time-horizon; (ii) further validation in an independent sample; and (iii) performance comparison in a real-life vs a clinical trial setting.<br />Design: Observational prospective randomized clinical trial.<br />Setting: White patients with type 2 diabetes.<br />Patients: Gargano Mortality Study (GMS; n = 1019), Foggia Mortality Study (FMS; n = 1045), and Pisa Mortality Study (PMS; n = 972) as real-life samples and the standard glycemic arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) clinical trial (n = 3150).<br />Main Outcome Measure: The endpoint was all-cause mortality. Prediction accuracy and calibration were estimated to assess the model's performances.<br />Results: ENFORCE yielded 6-year mortality C-statistics of 0.79, 0.78, and 0.75 in GMS, FMS, and PMS, respectively (P heterogeneity = 0.71). Pooling the three cohorts showed a 6-year mortality C-statistic of 0.80. In the ACCORD trial, ENFORCE achieved a C-statistic of 0.68, a value significantly lower than that obtained in the pooled real-life samples (P < 0.0001). This difference resembles that observed with other models comparing real-life vs clinical trial settings, thus suggesting it is a true, replicable phenomenon.<br />Conclusions: The time horizon of ENFORCE has been extended to 6 years and validated in three independent samples. ENFORCE is a free and user-friendly risk calculator of all-cause mortality in white patients with type 2 diabetes from a real-life setting.<br /> (Copyright © 2019 Endocrine Society.)
- Subjects :
- Aged
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 diagnosis
Female
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Randomized Controlled Trials as Topic statistics & numerical data
Risk Assessment
Risk Factors
Statistics as Topic methods
Diabetes Mellitus, Type 2 mortality
Models, Statistical
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 104
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 31087060
- Full Text :
- https://doi.org/10.1210/jc.2019-00215