The performance of diabetes risk prediction models in new populations: the role of ethnicity of the development cohort
- 332 Downloads
It is believed that diabetes risk scores need to be ethnic specific. However, this prerequisite has not been tested. We examined the performance of several risk models, developed in various populations, in a Europid and a South Asian population. The performance of 14 published risk prediction models were tested in two prospective studies: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study and the Mauritius non-communicable diseases survey. Eight models were developed in Europid populations; the remainder in various non-Europid populations. Model performance was assessed using area under the receiver operating characteristic curves (discrimination), Hosmer–Lemeshow tests (goodness-of-fit) and Brier scores (accuracy). In both AusDiab and Mauritius, discrimination was highest for a model developed in a mixed population (non-Hispanic white and African American) and lowest for a model developed in a Europid population. Discrimination for all scores was higher in AusDiab than in Mauritius. For almost all models, goodness-of-fit was poor irrespective of the ethnicity of the development cohort, and accuracy was higher in AusDiab compared to Mauritius. Our results suggest that similarity of ethnicity or similarity of diabetes risk may not be the best way of identifying models that will perform well in another population. Differences in study methodology likely account for much of the difference in the performance. Thus, identifying models which use measurements that are clearly described and easily reproducible for both research and clinical settings may be more important.
KeywordsRisk prediction model Diabetes Performance Discrimination Calibration
The AusDiab study co-coordinated by the Baker IDI Heart and Diabetes Institute is enormously grateful to Anne Allman from the Baker IDI Heart and Diabetes Institute, Robert Atkins from Monash University, Stan Bennett from the Australian Institute of Health and Welfare, Annaliese Bonney from the Baker IDI Heart and Diabetes Institute, Steven Chadban from the University of Sydney, Max de Courten from the Baker IDI Heart and Diabetes Institute, Marita Dalton from the Baker IDI Heart and Diabetes Institute, Terrance Dwyer from the Murdoch Children’s Research Institute, Royal Melbourne Hospital, Hassan Jahangir from the Baker IDI Heart and Diabetes Institute, Damien Jolley from Monash University, Dan McCarty from the Baker IDI Heart and Diabetes Institute, Adam Meehan from the Baker IDI Heart and Diabetes Institute, Nicole Meinig from the Baker IDI Heart and Diabetes Institute, Shirley Murray from the Baker IDI Heart and Diabetes Institute, Kerin O’Dea from the University of Melbourne, Kevin Polkinghorne from Monash University, Patrick Phillips from the Queen Elizabeth Hospital, Adelaide, Clare Reid from the Baker IDI Heart and Diabetes Institute, Alison Stewart from the Baker IDI Heart and Diabetes Institute, Robyn Tapp from the Baker IDI Heart and Diabetes Institute, Hugh Taylor from the Centre for Eye Research, Australia, Theresa Whalen from the Baker IDI Heart and Diabetes Institute and Fay Wilson from the Baker IDI Heart and Diabetes Institute and the Victorian Government’s OIS Program for their invaluable contribution to the set-up and field activities of AusDiab. The baseline Mauritius NCD surveys were funded by the World Health Organization, Baker IDI Heart and Diabetes Institute, the University of Newcastle upon Tyne (UK), and the National Public Health Institute, Finland, and by the National Institutes of Health (Grant DK-25446). We are most grateful to the staff at the Ministry of Health and Quality of Life in Mauritius for conducting both the baseline and the follow-up study. We thank the participants for volunteering their time to be involved in the study. We acknowledge, in particular, the work of Gary Dowse, Department of Health, Western Australia; Max De Courten, University of Copenhagen, Copenhagen, Denmark; Ray Sparks, Department of Pathology, Monash University, Melbourne, Victoria, Australia; Pierrot Chitson, Ministry of Health, Mauritius. JES is supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship. DJM and SKT are supported by NHMRC Grants. S.S. is supported by Grants from the Vasterbotten Country Council and the Swedish Heart and Lung Foundation.
Conflict of interest
Stephanie K Tanamas, Dianna J Magliano, Beverley Balkau, Jaakko Tuomilehto, Sudhir Kowlessur, Stefan Söderberg, Paul Z Zimmet, Jonathan E Shaw declare that they have no conflict of interest.
Human and animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was obtained from all participants included in the study.
- 1.International Diabetes Federation (2013) IDF Diabetes Atlas 6th edition. In. IDFGoogle Scholar
- 5.Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V (2006) The indian diabetes prevention programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49:289–297PubMedCrossRefGoogle Scholar
- 15.World Health Organization (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation in. World Health Org, GenevaGoogle Scholar