External validation of the UK Prospective Diabetes Study (UKPDS) risk engine in patients with type 2 diabetes

S. Van Dieren*, L. M. Peelen, U. Nöthlings, Y. T. Van Der Schouw, G. E.H.M. Rutten, A. M.W. Spijkerman, D. L. Van Der A, D. Sluik, H. Boeing, K. G.M. Moons, J. W.J. Beulens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims/hypothesis: Treatment guidelines recommend the UK Prospective Diabetes Study (UKPDS) risk engine for predicting cardiovascular risk in patients with type 2 diabetes, although validation studies showed moderate performance. The methods used in these validation studies were diverse, however, and sometimes insufficient. Hence, we assessed the discrimination and calibration of the UKPDS risk engine to predict 4, 5, 6 and 8 year cardiovascular risk in patients with type 2 diabetes. Methods: The cohort included 1,622 patients with type 2 diabetes. During a mean follow-up of 8 years, patients were followed for incidence of CHD and cardiovascular disease (CVD). Discrimination and calibration were assessed for 4, 5, 6 and 8 year risk. Discrimination was examined using the c-statistic and calibration by visually inspecting calibration plots and calculating the Hosmer-Lemeshow χ2 statistic. Results: The UKPDS risk engine showed moderate to poor discrimination for both CHD and CVD (c-statistic of 0.66 for both 5 year CHD and CVD risks), and an overestimation of the risk (224% and 112%). The calibration of the UKPDS risk engine was slightly better for patients with type 2 diabetes who had been diagnosed with diabetes more than 10 years ago compared with patients diagnosed more recently, particularly for 4 and 5 year predicted CVD and CHD risks. Discrimination for these periods was still moderate to poor. Conclusions/interpretation: We observed that the UKPDS risk engine overestimates CHD and CVD risk. The discriminative ability of this model is moderate, irrespective of various subgroup analyses. To enhance the prediction of CVD in patients with type 2 diabetes, this model should be updated.

Original languageEnglish
Pages (from-to)264-270
Number of pages7
JournalDiabetologia
Volume54
Issue number2
DOIs
Publication statusPublished - 1 Feb 2011

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