Durability of glycaemic control in patients with type 2 diabetes after metformin failure: Prognostic model derivation and validation using the DISCOVER study.
Durability of glycaemic control in patients with type 2 diabetes after metformin failure: Prognostic model derivation and validation using the DISCOVER study.
复制标题
二甲双胍失败后 2 型糖尿病患者血糖控制的持久性：使用 DISCOVER 研究进行预后模型推导和验证。
DOI：
10.1111/dom.13966
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Ling S
中科院分区：
文献类型：
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作者：
Ling S
AimTo develop and internally validate prognostic models on the long-term durability of emergency control in patients with type 2 diabetes after metformin failure.Materials and MethodsDISCOVER是一项为期3年的前瞻性观察性研究，横跨六大洲，调查二线降糖治疗。在这项来自35个国家的分析中，我们纳入了因医生定义的疗效缺乏而开始二线降糖药物治疗的二甲双胍患者。结局是血糖控制的持久性，定义为6个月、12个月和24个月随访时HbA 1c连续3个水平达到目标（基线HbA 1c ≤7% [53 mmol/mol]的患者HbA 1c等于或低于医生开始二线治疗时的水平;基线HbA 1c>7%的患者HbA 1c等于或低于7%）。我们开发并内部验证了两个预后模型：一个基础模型，包括年龄、性别、种族、国家收入组、基线HbA 1c和二线治疗;一个高级模型，通过从一个模型中选择统计变量建立，该模型包括基础变量和从文献综述中选择的13个额外预测因子。我们使用逻辑回归开发和500个自举样本内部验证模型;歧视和校准被用来评估模型performance.ResultsOverall，896 2995参与者（29.9%）有持续的血糖控制。基础模型表现良好：内部验证后，NagelkerkeR 2为0.13，C指数为0.70（95% CI：0.68，0.71），偏倚校正C指数为0.69。在高级模型中额外选择了糖尿病病程、保险类型、估计的肾小球滤过率和血糖自我监测，其性能仅略优于基础模型：NagelkerkeR 20. 20，C指数0. 71（95% CI：0. 69，0. 73）和偏倚校正C指数0. 70。校准图显示两个验证models.ConclusionThese预后模型，其中包括简单的人口统计学和常规收集的临床信息，使二甲双胍失败后的患者2年持续血糖控制的概率估计。这些模型已被实施到一个基于网络的工具中，以支持医疗保健专业人员的决策。
AimTo develop and internally validate prognostic models on the long‐term durability of glycaemic control in patients with type 2 diabetes after metformin failure.Materials and MethodsDISCOVER is a 3‐year, prospective observational study across six continents investigating second‐line glucose‐lowering therapies. In this analysis from 35 countries, we included patients on metformin initiating second‐line glucose‐lowering medication(s) because of physician‐defined lack of efficacy. The outcome was durability of glycaemic control, defined as three consecutive levels of HbA1c at 6‐, 12‐ and 24‐month follow‐up at target (HbA1c equal to or lower than the level when the physician initiated the second‐line therapy in patients with baseline HbA1c ≤7% [53 mmol/mol]; and equal to or lower than 7% in those with baseline HbA1c >7%). We developed and internally validated two prognostic models: a base model, which included age, sex, ethnicity, country income group, baseline HbA1c and second‐line therapy, and an advanced model, established through statistical variable selections from a model including base variables and 13 additional predictors selected from a literature review. We used logistic regression to develop and 500 bootstrapping samples to internally validate the models; discrimination and calibration were used to assess model performance.ResultsOverall, 896 out of 2995 participants (29.9%) had sustained glycaemic control. The base model performed well:NagelkerkeR2was 0.13, C‐index 0.70 (95% CI: 0.68, 0.71) and bias‐corrected C‐index 0.69 after internal validation. Diabetes duration, insurance type, estimated glomerular filtration rate and glucose self‐monitoring were additionally selected in the advanced model, which had only a slightly better performance compared with the base model:NagelkerkeR20.20, C‐index 0.71 (95% CI: 0.69, 0.73) and bias‐corrected C‐index 0.70. Calibration plots showed good calibrations of both validated models.ConclusionThese prognostic models, which include simple demographic and routinely collected clinical information, enabled the estimation of the probability of 2‐year sustained glycaemic control in patients after metformin failure. The models have been implemented into a web‐based tool to support healthcare professionals in their decisions.