Prediction of incident diabetes mellitus in middle-aged adults - The Framingham Offspring Study
Prediction of incident diabetes mellitus in middle-aged adults - The Framingham Offspring Study
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DOI：
10.1001/archinte.167.10.1068
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发表时间：
2007-05-28
影响因子：
--
通讯作者：
D'Agostino, Ralph B., Sr.
中科院分区：
文献类型：
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作者：
Wilson, Peter W. F.;Meigs, James B.;D'Agostino, Ralph B., Sr.
背景资料：2型糖尿病（T2 DM）的预测规则已经制定，但我们缺乏共识的最有效的approach.Methods：我们估计了7年的风险T2 DM的中年参与者在基线口服葡萄糖耐量试验。有160例新发T2 DM病例，从受试者已知的特征开始，使用回归模型预测新发T2 DM（个人模型，即年龄、性别、父母糖尿病史和体重指数[计算方法为体重（千克）除以身高（米）的平方]），增加了包括代谢综合征特征在内的简单临床测量（简单临床模型），最后评估复杂的临床模型，包括（1）口服葡萄糖耐量试验后2小时的葡萄糖、空腹胰岛素和C-反应蛋白水平;（2）Gutt胰岛素敏感性指数;或（3）稳态模型胰岛素抵抗和稳态模型胰岛素抵抗β细胞敏感性指数。结果：除性别外，个人模型变量对T2 DM有显著预测作用（AROC，0.72）。在简单的临床模型中，父母的糖尿病和肥胖史仍然是重要的预测因素，沿着高血压、低水平的高密度脂蛋白胆固醇、升高的甘油三酯水平和空腹血糖受损，但不是腰围过大（AROC，0.85）。复杂的临床模型没有进一步改善模型的歧视（AROC，0.850-0.854），并没有上级到简单的临床model.Conclusion：父母的糖尿病，肥胖和代谢综合征特征有效地预测T2 DM的风险在中年白色人群样本，并用于开发一个简单的T2 DM预测算法，估计新的T2 DM的风险在7年的随访间隔。
Background: Prediction rules for type 2 diabetes mellitus (T2DM) have been developed, but we lack consensus for the most effective approach.Methods: We estimated the 7-year risk of T2DM in middle-aged participants who had an oral glucose tolerance test at baseline. There were 160 cases of new T2DM, and regression models were used to predict new T2DM, starting with characteristics known to the subject (personal model, ie, age, sex, parental history of diabetes, and body mass index [calculated as the weight in kilograms divided by height in meters squared]), adding simple clinical measurements that included metabolic syndrome traits (simple clinical model), and, finally, assessing complex clinical models that included (1) 2-hour post-oral glucose tolerance test glucose, fasting insulin, and C-reactive protein levels; (2) the Gutt insulin sensitivity index; or (3) the homeostasis model insulin resistance and the homeostasis model insulin resistance beta- cell sensitivity indexes. Discrimination was assessed with area under the receiver operating characteristic curves (AROCs).Results: The personal model variables, except sex, were statistically significant predictors of T2DM (AROC, 0.72). In the simple clinical model, parental history of diabetes and obesity remained significant predictors, along with hyper-tension, low levels of high-density lipoprotein cholesterol, elevated triglyceride levels, and impaired fasting glucose findings but not a large waist circumference (AROC, 0.85). Complex clinical models showed no further improvement in model discriminations (AROC, 0.850-0.854) and were not superior to the simple clinical model.Conclusion: Parental diabetes, obesity, and metabolic syndrome traits effectively predict T2DM risk in a middleaged white population sample and were used to develop a simple T2DM prediction algorithm to estimate risk of new T2DM during a 7-year follow-up interval.