Prediction of 5-year risk of diabetes mellitus in relatively low risk middle-aged and elderly adults
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To determine the potential risk factors and construct the predictive model of diabetic risk among a relatively low risk middle-aged and elderly Chinese population.
Information of participants was collected in the Dongfeng-Tongji cohort study, a perspective cohort study of Chinese occupational population. The main outcome was incident type 2 diabetes (T2DM). Based on the conventional risk factors of diabetes, we defined low risk participants without underlying diseases such as coronary heart disease, stroke, cancer, dyslipidemia, hypertension, metabolic syndrome, obesity and family history of diabetes. Totally, 4833 participants from the Dongfeng-Tongji cohort study were enrolled, and of them, 171 had an incident diagnosis of T2DM during 4.6 years of follow-up period. A Cox proportional hazards model was used to estimate effects of risk factors. The restricted cubic spline regression and the Youden index were used to explore the optimal cutoffs of risk factors, and the C index was used to assess the discrimination power of prediction models.
There were significant linear relationships between BMI/TG level/fasting glucose level and incident diabetic risk among low risk participants. In the restricted cubic spline regression, when fasting glucose level was above 5.4 mmol/L, TG above 1.06 mmol/L and BMI above 22 kg/m2, the HRs (95% CIs) of diabetes were above 1.0. The detailed HRs (95% CI) were 1.29 (1.01, 1.64), 2.57 (1.00, 6.58), and 1.49 (1.00, 2.22), respectively. The optimal cutoff determined by the Yonden index was 1.1 mmol/L for TG, 24 kg/m2 for BMI and 5.89 mmol/L for fasting plasma glucose, respectively. The C index was 0.75 (95% CI: 0.7–0.81) when age, sex, smoke status, physical activity, BMI (< 24 kg/m2 and ≥ 24 kg/m2), TG (< 1.1 mmol/L and ≥ 1.1 mmol/L), and FPG (< 5.89 mmol/L and ≥ 5.89 mmol/L) were introduced into the diabetes predictive model.
Fasting plasma glucose level, BMI, and triglyceride level were still dominated factors to predict 5-year diabetic risk among the relatively low risk participants. The cutoff values for fasting plasma glucose, TG, and BMI set as 5.89 mmol/L, 1.1 mmol/L, and 24 kg/m2, respectively, had the best predictive discrimination of diabetes.
KeywordsPrediction model Perspective cohort study Type 2 diabetes
Hua Hu, and Meian He conceived and designed the study. All authors acquired, analyzed, or interpreted data and critically revised the manuscript for important intellectual content. Jing Yuan, Xiaoping Miao checked the data extraction. Hua Hu did the statistical analysis and drafted the manuscript. Meian He obtained funding and supervised the study. Meian He had full access to all of the data and took responsibility for the integrity of the data and the accuracy of the data analysis.
This work was supported by the Grants from the National Natural Science Foundation (Grants NSFC-81473051 and 81522040) and the Program for HUST Academic Frontier Youth Team.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Ethics and Human Subject Committee of School of Public Health, Tongji Medical College, Huazhong University of Science and Technology and Dongfeng General Hospital, DMC.
All participants in this study gave written informed consent.
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