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Article
Are population-based diabetes models useful for individual risk estimation
Meyers Primary Care Institute Publications and Presentations
  • Barry G. Saver, University of Massachusetts Medical School
  • J. Lee Hargraves, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
UMMS Affiliation
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Date
7-9-2011
Document Type
Article
Abstract

BACKGROUND: Predictive models are increasingly used in guidelines and informed decision-making interventions. We compared predictions from 2 prominent models for diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) outcomes model and the Archimedes-based Diabetes Personal Health Decisions (PHD) model.

METHODS: Ours was a simulation study comparing 10-year and 20-year model predictions for risks of myocardial infarction (MI), stroke, amputation, blindness, and renal failure for representative test cases.

RESULTS: The Diabetes PHD model predicted substantially higher risks of MI and stroke in most cases, particularly for stroke and for 20-year outcomes. In contrast, the UKPDS model predicted risks of amputation and blindness ranging from 2-fold to infinitely higher than the Diabetes PHD model. Predictions for renal failure all differed by more than 2-fold but in a complicated pattern varying by time frame and specific risk factors. Relative to their predictions for white men, the UKPDS model predicted much lower MI and stroke risks for women and Afro-Caribbean men than the Diabetes PHD model did for women and black men. A substantial majority of the Diabetes PHD point estimates fell outside of the UKPDS outcomes model's 95% CIs.

CONCLUSIONS: These models produced markedly different predictions. Patients and providers considering risk estimates from such models need to understand their substantial uncertainty and risk of misclassification.

Rights and Permissions
Citation: J Am Board Fam Med. 2011 Jul-Aug;24(4):399-406. Link to article on publisher's site
Related Resources
Link to Article in PubMed
PubMed ID
21737764
Citation Information
Barry G. Saver, J. Lee Hargraves and Kathleen M. Mazor. "Are population-based diabetes models useful for individual risk estimation" Vol. 24 Iss. 4 (2011) ISSN: 1557-2625 (Linking)
Available at: http://works.bepress.com/barry_saver/35/