Ten-year risk prediction models of complications and mortality of Chinese patients with diabetes mellitus in primary care in Hong Kong: a study protocol

Abstract

IntroductionDiabetes mellitus (DM) is a major disease burden worldwide because it is associated with disabling and lethal complications. DM complication risk assessment and stratification is key to cost-effective management and tertiary prevention for patients with diabetes in primary care. Existing risk prediction functions were found to be inaccurate in Chinese patients with diabetes in primary care. This study aims to develop 10-year risk prediction models for total cardiovascular diseases (CVD) and all-cause mortality among Chinese patients with DM in primary care.Methods and analysisA 10-year cohort study on a population-based primary care cohort of Chinese patients with diabetes, who were receiving care in the Hospital Authority General Outpatient Clinic on or before 1 January 2008, were identified from the clinical management system database of the Hospital Authority. All patients with complete baseline risk factors will be included and followed from 1 January 2008 to 31 December 2017 for the development and validation of prediction models. The analyses will be carried out separately for men and women. Two-thirds of subjects will be randomly selected as the training sample for model development. Cox regressions will be used to develop 10-year risk prediction models of total CVD and all-cause mortality. The validity of models will be tested on the remaining one-third of subjects by Harrell’s C-statistics and calibration plot. Risk prediction models for diabetic complications specific to Chinese patients in primary care will enable accurate risk stratification, prioritisation of resources and more cost-effective interventions for patients with DM in primary care.Ethics and disseminationThe study was approved by the Institutional Review Board of the University of Hong Kong—the Hospital Authority Hong Kong West Cluster (reference number: UW 15–258).Trial registration numberNCT03299010; Pre-results.

Individualised risk prediction model for new-onset, progression and regression of chronic kidney disease in a retrospective cohort of patients with type 2 diabetes under primary care in Hong Kong

“…In fact, many prediction models also used the year since enrolment as a time indicator, including a few local studies. 8 35 …”

“…5 Specifically for people with type 2 diabetes, several prediction models have been reported in the literature, but most were Cox proportional hazards regression models on all-cause mortality and incidence of CVD. [6][7][8][9] Previous studies have investigated the risk factors that significantly predicted ESRD in Chinese populations 10 11 , but none focused on CKD progression at earlier stages nor on CKD regression.…”

An individualized risk prediction model for new-onset, progression and regression of chronic kidney disease in a retrospective cohort of patients with type 2 diabetes under primary care in Hong Kong

“…However, this could be very difficult to achieve, as many patients did not have timely laboratory tests for diagnosis. In fact, many prediction models also used the year since enrolment as time indicator, including a few local studies 8 35 .…”

Prediction models and nomograms for 10‐year risk of end‐stage renal disease in Chinese type 2 diabetes mellitus patients in primary care

“…Data were extracted from the clinical management system of the Hong Kong Hospital Authority in June 2018. The inclusion and exclusion criteria were determined to match the T2DM patients in primary care clinics without serious complications 19 . We included all patients aged 18 years or above with a clinical diagnosis of T2DM, defined by the International Classification of Primary Care, second edition codes of T90, between 1 January and 31 December 2008.…”