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The Hong Kong Diabetes Registry

Xilin Yang, PhD; Wing Yee So, MBChB, FRCP; Peter C. Y. Tong, MBBS, PhD, FRCP; Ronald C. W. Ma, MBChB, MRCP; Alice P. S. Kong, MBChB, FRCP; Christopher W. K. Lam, PhD, HonFRCPath; Chung Shun Ho, PhD; Clive S. Cockram, MD, FRCP; Gary T. C. Ko, MD, FRCP; Chun-Chung Chow, MBBS, FRCP; Vivian C. W. Wong, MBBS, FRCOG; Juliana C. N. Chan, MD, FRCP

Arch Intern Med. 2008;168(5):451-457.

Background  Diabetes reduces life expectancy by 10 to 12 years, but whether death can be predicted in type 2 diabetes mellitus remains uncertain.

Methods  A prospective cohort of 7583 type 2 diabetic patients enrolled since 1995 were censored on July 30, 2005, or after 6 years of follow-up, whichever came first. A restricted cubic spline model was used to check data linearity and to develop linear-transforming formulas. Data were randomly assigned to a training data set and to a test data set. A Cox model was used to develop risk scores in the test data set. Calibration and discrimination were assessed in the test data set.

Results  A total of 619 patients died during a median follow-up period of 5.51 years, resulting in a mortality rate of 18.69 per 1000 person-years. Age, sex, peripheral arterial disease, cancer history, insulin use, blood hemoglobin levels, linear-transformed body mass index, random spot urinary albumin-creatinine ratio, and estimated glomerular filtration rate at enrollment were predictors of all-cause death. A risk score for all-cause mortality was developed using these predictors. The predicted and observed death rates in the test data set were similar (P > .70). The area under the receiver operating characteristic curve was 0.85 for 5 years of follow-up. Using the risk score in ranking cause-specific deaths, the area under the receiver operating characteristic curve was 0.95 for genitourinary death, 0.85 for circulatory death, 0.85 for respiratory death, and 0.71 for neoplasm death.

Conclusions  Death in type 2 diabetes mellitus can be predicted using a risk score consisting of commonly measured clinical and biochemical variables. Further validation is needed before clinical use.

Author Affiliations: Department of Medicine and Therapeutics (Drs Yang, So, Tong, Ma, Kong, Cockram, Ko, Chow, and Chan), Hong Kong Institute of Diabetes and Obesity (Drs Tong, Ko, and Chan), Li Ka Shing Institute of Health Sciences (Drs Kong and Chan), and Department of Chemical Pathology (Drs Lam and Ho), Chinese University of Hong Kong; and Hospital Authority Head Office, Hong Kong (Dr Wong).