Diabetes Metab J.  2018 Oct;42(5):402-414. 10.4093/dmj.2018.0014.

Development and Validation of the Korean Diabetes Risk Score: A 10-Year National Cohort Study

Affiliations
  • 1Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea. djkim@ajou.ac.kr
  • 2Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 5Department of Family Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 6Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 7Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

Abstract

BACKGROUND
A diabetes risk score in Korean adults was developed and validated.
METHODS
This study used the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) of 359,349 people without diabetes at baseline to derive an equation for predicting the risk of developing diabetes, using Cox proportional hazards regression models. External validation was conducted using data from the Korean Genome and Epidemiology Study. Calibration and discrimination analyses were performed separately for men and women in the development and validation datasets.
RESULTS
During a median follow-up of 10.8 years, 37,678 cases (event rate=10.4 per 1,000 person-years) of diabetes were identified in the development cohort. The risk score included age, family history of diabetes, alcohol intake (only in men), smoking status, physical activity, use of antihypertensive therapy, use of statin therapy, body mass index, systolic blood pressure, total cholesterol, fasting glucose, and γ glutamyl transferase (only in women). The C-statistics for the models for risk at 10 years were 0.71 (95% confidence interval [CI], 0.70 to 0.73) for the men and 0.76 (95% CI, 0.75 to 0.78) for the women in the development dataset. In the validation dataset, the C-statistics were 0.63 (95% CI, 0.53 to 0.73) for men and 0.66 (95% CI, 0.55 to 0.76) for women.
CONCLUSION
The Korean Diabetes Risk Score may identify people at high risk of developing diabetes and may be an effective tool for delaying or preventing the onset of condition as risk management strategies involving modifiable risk factors can be recommended to those identified as at high risk.

Keyword

Diabetes mellitus; Risk assessment; Risk factors; Korea

MeSH Terms

Adult
Blood Pressure
Body Mass Index
Calibration
Cholesterol
Cohort Studies*
Dataset
Diabetes Mellitus
Discrimination (Psychology)
Epidemiology
Fasting
Female
Follow-Up Studies
Genome
Glucose
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Korea
Male
Mass Screening
Motor Activity
National Health Programs
Risk Assessment
Risk Factors
Risk Management
Smoke
Smoking
Transferases
Cholesterol
Glucose
Smoke
Transferases

Figure

  • Fig. 1 Calibration plots with C-statistics in the (A, B) development and (C, D) validation cohorts. Data markers represent the observed event rate (position on the y-axis) in relation to the predicted event rate (position on the x-axis); dotted lines, perfect calibration (i.e., observed=predicted).

  • Fig. 2 Cumulative incidence of diabetes events according to (A) sex, (B) age, (C) body mass index, (D) systolic blood pressure, (E) fasting glucose, and (F) total cholesterol.


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