Development and validation of a model for predicting incident type 2 diabetes using quantitative clinical data and a Bayesian logistic model: A nationwide cohort and modeling study

Autoři: Lua Wilkinson aff001;  Nengjun Yi aff003;  Tapan Mehta aff004;  Suzanne Judd aff003;  W. Timothy Garvey aff001
Působiště autorů: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America aff001;  Novo Nordisk, Plainsboro, New Jersey, United States of America aff002;  Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America aff003;  Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, United States of America aff004;  Birmingham VA Medical Center, Alabama, United States of America aff005
Vyšlo v časopise: Development and validation of a model for predicting incident type 2 diabetes using quantitative clinical data and a Bayesian logistic model: A nationwide cohort and modeling study. PLoS Med 17(8): e32767. doi:10.1371/journal.pmed.1003232
Kategorie: Research Article



Obesity is closely related to the development of insulin resistance and type 2 diabetes (T2D). The prevention of T2D has become imperative to stem the rising rates of this disease. Weight loss is highly effective in preventing T2D; however, the at-risk pool is large, and a clinically meaningful metric for risk stratification to guide interventions remains a challenge. The objective of this study is to predict T2D risk using full-information continuous analysis of nationally sampled data from white and black American adults age ≥45 years.

Methods and findings

A sample of 12,043 black (33%) and white individuals from a population-based cohort, REasons for Geographic And Racial Differences in Stroke (REGARDS) (enrolled 2003–2007), was observed through 2013–2016. The mean participant age was 63.12 ± 8.62 years, and 43.7% were male. Mean BMI was 28.55 ± 5.61 kg/m2. Risk factors for T2D regularly recorded in the primary care setting were used to evaluate future T2D risk using Bayesian logistic regression. External validation was performed using 9,710 participants (19% black) from Atherosclerotic Risk in Communities (ARIC) (enrolled 1987–1989), observed through 1996–1998. The mean participant age in this cohort was 53.86 ± 5.65 years, and 44.6% were male. Mean BMI was 27.15 ± 4.92 kg/m2. Predictive performance was assessed using the receiver operating characteristic (ROC) curves and area under the curve (AUC) statistics. The primary outcome was incident T2D. By 2016 in REGARDS, there were 1,602 incident cases of T2D. Risk factors used to predict T2D progression included age, sex, race, BMI, triglycerides, high-density lipoprotein, blood pressure, and blood glucose. The Bayesian logistic model (AUC = 0.79) outperformed the Framingham risk score (AUC = 0.76), the American Diabetes Association risk score (AUC = 0.64), and a cardiometabolic disease system (using Adult Treatment Panel III criteria) (AUC = 0.75). Validation in ARIC was robust (AUC = 0.85). Main limitations include the limited generalizability of the REGARDS sample to black and white, older Americans, and no time to diagnosis for T2D.


Our results show that a Bayesian logistic model using full-information continuous predictors has high predictive discrimination, and can be used to quantify race- and sex-specific T2D risk, providing a new, powerful predictive tool. This tool can be used for T2D prevention efforts including weight loss therapy by allowing clinicians to target high-risk individuals in a manner that could be used to optimize outcomes.

Klíčová slova:

Blood pressure – Blood sugar – Cholesterol – Medical risk factors – Obesity – Type 2 diabetes – Weight loss – Type 2 diabetes risk


1. Centers for Disease Control and Prevention. National diabetes statistics report 2017: estimates of diabetes and its burden in the United States. Atlanta: Centers for Disease Control and Prevention; 2017.

2. Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25:2165–71. doi: 10.2337/diacare.25.12.2165 12453955

3. Guo F, Garvey WT. Cardiometabolic disease staging predicts effectiveness of weight loss therapy to prevent type 2 diabetes: pooled results from phase III clinical trials assessing phentermine/topiramate extended release. Diabetes Care. 2017;40(7):856–62. doi: 10.2337/dc17-0088 28455281

4. Booth H, Khan O, Prevost T, Reddy M, Dregan A, Charlton J, et al. Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study. Lancet Diabetes Endocrinol. 2014;2(12):963–8. doi: 10.1016/S2213-8587(14)70214-1 25466723

5. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112(17):2735–52. doi: 10.1161/CIRCULATIONAHA.105.169404 16157765

6. Eisenmann JC. On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol. 2008;7(1):17.

7. DeBoer MD, Gurka MJ. Clinical utility of metabolic syndrome severity scores: considerations for practitioners. Diabetes Metab Syndr Obes. 2017;10:65–72. doi: 10.2147/DMSO.S101624 28255250

8. Noble D, Mathur R, Dent T, Meads C, Greenhalgh T. Risk models and scores for type 2 diabetes: systematic review. BMJ. 2011;343:d7163. doi: 10.1136/bmj.d7163 22123912

9. Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity (Silver Spring). 2014;22(1):110–8.

10. Friedman GD, Cutter GR, Donahue RP, Hughes GH, Hulley SB, Jacobs DR, et al. CAR DIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41(11):1105–16. doi: 10.1016/0895-4356(88)90080-7 3204420

11. The Atherosclerosis Risk in Communities (ARIC) study: design and objectives. The ARIC Investigators. Am J Epidemiol. 1989;129(4):687–702. 2646917

12. Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31(9):1898–904. doi: 10.2337/dc08-0423 18591398

13. Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal—joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2005;28(9):2289–304.

14. Gurka MJ, Golden SH, Musani SK, Sims M, Vishnu A, Guo Y, et al. Independent associations between a metabolic syndrome severity score and future diabetes by sex and race: the Atherosclerosis Risk In Communities Study and Jackson Heart Study. Diabetologia. 2017;60(7):1261–70. doi: 10.1007/s00125-017-4267-6 28378033

15. Abbasi A, Peelen LM, Corpeleijn E, van der Schouw YT, Stolk RP, Spijkerman AMW, et al. Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study. BMJ. 2012;345:e5900. doi: 10.1136/bmj.e5900 22990994

16. Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005;25(3):135–43. doi: 10.1159/000086678 15990444

17. Schmidt MI, Duncan BB, Bang H, Pankow JS, Ballantyne CM, Golden SH, et al. Identifying individuals at high risk for diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care. 2005;28(8):2013–8. doi: 10.2337/diacare.28.8.2013 16043747

18. Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, et al. Low-grade systemic inflammation and the development of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes. 2003;52(7):1799–805. doi: 10.2337/diabetes.52.7.1799 12829649

19. Guo F, Garvey WT. Development of a weighted cardiometabolic disease staging (CMDS) system for the prediction of future diabetes. J Clin Endocrinol Metab. 2015;100(10):3871–7. doi: 10.1210/jc.2015-2691 26241327

20. Gelman A, Jakulin A, Pittau MG, Su YS. A weakly informative default prior distribution for logistic and other regression models. Ann Appl Stat. 2008;2(4):1360–83.

21. Gelman A, Carlin JB, Stern HS, Dunson DB, Vehtari A, Rubin DB. Bayesian data analysis. 3rd edition. Boca Raton: Chapman and Hall/CRC Press; 2014.

22. Ivanescu AE, Li P, George B, Brown AW, Keith SW, Raju D, et al. The importance of prediction model validation and assessment in obesity and nutrition research. Int J Obes. 2016;40(6):887–94.

23. Alba AC, Agoritsas T, Walsh M, Hanna S, Iorio A, Devereaux PJ, et al. Discrimination and calibration of clinical prediction models. JAMA. 2017;318(14):1377. doi: 10.1001/jama.2017.12126 29049590

24. Yi N, Tang Z, Zhang X, Guo B. BhGLM: Bayesian hierarchical GLMs and survival models, with applications to genomics and epidemiology. Bioinformatics. 2019;35(8):1419–21. doi: 10.1093/bioinformatics/bty803 30219850

25. Wilson PWF, Meigs JB, Sullivan L, Fox CS, Nathan DM, D’Agostino RB. Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med. 2007;167(10):1068–74. doi: 10.1001/archinte.167.10.1068 17533210

26. Bang H, Edwards AM, Bomback AS, Ballantyne CM, Brillon D, Callahan MA, et al. Development and validation of a patient self-assessment score for diabetes risk. Ann Intern Med. 2009;151(11):775–83. doi: 10.7326/0003-4819-151-11-200912010-00005 19949143

27. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

28. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(Suppl 3):1–203.

29. Long DL, Howard G, Long DM, Judd S, Manly JJ, McClure LA, et al. An investigation of selection bias in estimating racial disparity in stroke risk factors. Am J Epidemiol. 2019;188(3):587–97. doi: 10.1093/aje/kwy253 30452548

30. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403 doi: 10.1056/NEJMoa012512 11832527

31. Garvey WT, Ryan DH, Henry R, Bohannon NJV, Toplak H, Schwiers M, et al. Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended release. Diabetes Care. 2014;37(4):912–21. doi: 10.2337/dc13-1518 24103901

32. le Roux CW, Astrup A, Fujioka K, Greenway F, Lau DCW, Van Gaal L, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389(10077):1399–409. doi: 10.1016/S0140-6736(17)30069-7 28237263

Článek vyšel v časopise

PLOS Medicine

2020 Číslo 8
Nejčtenější tento týden
Nejčtenější v tomto čísle

Zvyšte si kvalifikaci online z pohodlí domova

Důležitost adherence při depresivním onemocnění
nový kurz
Autoři: MUDr. Eliška Bartečková, Ph.D.

Koncepce osteologické péče pro gynekology a praktické lékaře
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková, Ph.D.

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Multidisciplinární zkušenosti u pacientů s diabetem
Autoři: Prof. MUDr. Martin Haluzík, DrSc., prof. MUDr. Vojtěch Melenovský, CSc., prof. MUDr. Vladimír Tesař, DrSc.

Všechny kurzy
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se