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External validation of the UK prospective diabetes study (UKPDS) risk engine in patients with type 2 diabetes identified in the national diabetes program in Iran

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Abstract

Background

Cardiovascular diseases are the first leading cause of mortality in the world. Practical guidelines recommend an accurate estimation of the risk of these events for effective treatment and care. The UK Prospective Diabetes Study (UKPDS) has a risk engine for predicting CHD risk in patients with type 2 diabetes, but in some countries, it has been shown that the risk of CHD is poorly estimated. Hence, we assessed the external validity of the UKPDS risk engine in patients with type 2 diabetes identified in the national diabetes program in Iran.

Methods

The cohort included 853 patients with type 2diabetes identified between March 21, 2007, and March 20, 2018 in Lorestan province of Iran. Patients were followed for the incidence of CHD. The performance of the models was assessed in terms of discrimination and calibration. Discrimination was examined using the c-statistic and calibration was assessed with the Hosmer–Lemeshow χ2 statistic (HLχ2) test and a calibration plot was depicted to show the predicted risks versus observed ones.

Results

During 7464.5 person-years of follow-up 170 first Coronary heart disease occurred. The median follow-up was 8.6 years. The UKPDS risk engine showed moderate discrimination for CHD (c-statistic was 0.72 for 10-year risk) and the calibration of the UKPDS risk engine was poor (HLχ2 = 69.9, p < 0.001) and the UKPDS risk engine78% overestimated the risk of heart disease in patients with type 2 diabetes identified in the national diabetes program in Iran.

Conclusion

This study shows that the ability of the UKPDS Risk Engine to discriminate patients who developed CHD events from those who did not; was moderate and the ability of the risk prediction model to accurately predict the absolute risk of CHD (calibration) was poor and it overestimated the CHD risk. To improve the prediction of CHD in patients with type 2 diabetes, this model should be updated in the Iranian diabetic population.

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Data Availability

The data is available on request from the authors.

Abbreviations

AUROC:

Area Under the Receiver Operating Characteristic

BMI:

Body mass index

CVD:

Cardiovascular Disease

DCCT:

Diabetes Control and Complications Trial

DM:

Diabetes Mellitus

EPIC-Norfolk:

(European Prospective Investigation into Cancer) Norfolk study

FRS:

Framingham Risk Score Model

HbA1C:

Glycated hemoglobin A

HDL:

High-density lipoproteins

LDL:

low-density lipoprotein) cholesterol

ROC:

Receiver Operating Characteristic

SCORE:

Systematic Coronary Risk Evaluation

SD:

Standard Deviation

UKPDS:

UK Prospective Diabetes Study

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Acknowledgements

We thank all health care professionals in Lorestan province who helped to carry out this study.

Funding

This work was supported from Iran University of Medical Sceinces ( Nunmber-96-01-27-30511).

Author information

Author notes

  1. Mehrdad Valipour and Hamid Reza Baradaran contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Epidemiology, School of Public Heath, Iran University of Medical Sciences, Tehran, Iran

    Mehrdad Valipour, Masoud Solaymani-Dodaran, Seyed Abbas Motevalian & Hamid Reza Baradaran

  2. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Davood Khalili

  3. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Ebrahim Khamseh & Hamid Reza Baradaran

Authors
  1. Mehrdad Valipour
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  4. Seyed Abbas Motevalian
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  5. Mohammad Ebrahim Khamseh
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Contributions

MV, HRB, DK, SAM: conception or design of the work. MV, DK, HRB data collection, data analysis and interpretation, drafting the article,. MEK, SAM and MSD interpretation and critical revision of the article, final approval of the version to be published. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Davood Khalili.

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Ethics approval and consent to participate

The study was approved by the ethics institutional review board of Iran University of Medical Sceinces for studies in the community. It was exempted from signing informed consent forms.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Valipour, M., Khalili, D., Solaymani-Dodaran, M. et al. External validation of the UK prospective diabetes study (UKPDS) risk engine in patients with type 2 diabetes identified in the national diabetes program in Iran. J Diabetes Metab Disord 22, 1145–1150 (2023). https://doi.org/10.1007/s40200-023-01224-2

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