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Development and validation of risk prediction models for stroke and mortality among patients with type 2 diabetes in northern China

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Abstract

Background

Stroke is one of the leading causes of disability and mortality in patients with type 2 diabetes mellitus (T2DM). Risk models have been developed for predicting stroke and stroke-associated mortality among patients with T2DM. Here, we evaluated risk factors of stroke for individualized prevention measures in patients with T2DM in northern China.

Methods

In the community-based Tianjin Chronic Disease Cohort study, 58,042 patients were enrolled between January 2014 and December 2019. We used multiple imputation (MI) to impute missing variables and univariate and multivariate Cox’s proportional hazard regression to screen risk factors of stroke. Furthermore, we established and validated first-ever prediction models for stroke (Model 1 and Model 2) and death from stroke (Model 3) and evaluated their performance.

Results

In the derivation and validation groups, the area under the curves (AUCs) of Models 1–3 was better at 5 years than at 8 years. The Harrell’s C-index for all models was above 0.7. All models had good calibration, discrimination, and clinical net benefit. Sensitivity analysis using the MI dataset indicated that all models had good and stable prediction performance.

Conclusion

In this study, we developed and validated first-ever risk prediction models for stroke and death from stroke in patients with T2DM, with good discrimination and calibration observed in all models. Based on lifestyle, demographic characteristics, and laboratory examination, these models could provide multidimensional management and individualized risk assessment. However, the models developed here may only be applicable to Han Chinese.

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Data availability

The raw data are not available. However, the data are available from the corresponding author upon reasonable individual request.

Code availability

Not applicable.

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Acknowledgements

The authors thank the staff and participants of the study for their indispensable contributions.

Funding

This study was funded by the financial support from the National Natural Science Foundation of China (no.91746205), Open Project of Tianjin Key Laboratory of Metabolic Diseases (ZXY-ZDSYSZD2021-1), Tianjin Science and Technology Plan Project Public Health Science and Technology Major Special Project (No.21ZXGWSY00100), and Tianjin Key Medical Discipline (Specialty) Construct Project (No.TJYXZDXK-032A). The funder (Prof. Pei Yu) designed this study and was not for profit.

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Author notes

  1. X. Shao, H. Liu and F. Hou have contributed equally to the work.

Authors and Affiliations

  1. NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China

    X. Shao, H. Liu, Y. Bai, Y. Lin, X. Jiang, P. Bai, Y. Wang, S. Zhou & P. Yu

  2. Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China

    X. Shao, H. Liu, Y. Bai, Y. Lin, X. Jiang, P. Bai, Y. Wang, S. Zhou & P. Yu

  3. Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China

    F. Hou, Y. Zhang, C. Lu & H. Liu

  4. Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China

    Z. Cui

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  1. X. Shao
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Contributions

XS, HYL, and FH contributed equally to this study. XS prepared the figures and wrote the manuscript. PY designed this study; YL, XJ, PFB, YRZ, CLL, HL, and FH recorded and prepared the data; XS, HYL, and FH analyzed the data and interpreted the results of the study; SJZ, FH, and YB edited and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to P. Yu.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was reviewed and approved by the ethics committee of Tianjin Chu Hsien-l Memorial Hospital. The study was registered in the Chinese Clinical Trial Register with the identification number ChiCTR1900023701 (2019/06/08).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Verbal informed consent was obtained from each participant and was recorded by the physician who explained the study procedures.

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Written informed consent for publication was obtained from all participants.

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Shao, X., Liu, H., Hou, F. et al. Development and validation of risk prediction models for stroke and mortality among patients with type 2 diabetes in northern China. J Endocrinol Invest 46, 271–283 (2023). https://doi.org/10.1007/s40618-022-01898-0

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