Abstract
(1) Background: A disease prediction model derived from real-world data is an important tool for managing type 2 diabetes mellitus (T2D). However, an appropriate prediction model for the Asian T2D population has not yet been developed. Hence, this study described construction details of the T2D Holistic Care model via estimating the probability of diabetes-related complications and the time-to-occurrence from a population-based database. (2) Methods: The model was based on the database of a Taiwan pay-for-performance reimbursement scheme for T2D between November 2002 and July 2017. A nonhomogeneous Markov model was applied to simulate multistate (7 main complications and death) transition probability after considering the sequential and repeated difficulties. (3) Results: The Markov model was constructed based on clinical care information from 163,452 patients with T2D, with a mean follow-up time of 5.5 years. After simulating a cohort of 100,000 hypothetical patients over a 10-year time horizon based on selected patient characteristics at baseline, a good predicted complication and mortality rates with a small range of absolute error (0.3–3.2%) were validated in the original cohort. Better and optimal predictabilities were further confirmed compared to the UKPDS Outcomes model and applied the model to other Asian populations, respectively. (4) Contribution: The study provides well-elucidated evidence to apply real-world data to the estimation of the occurrence and time point of major diabetes-related complications over a patient’s lifetime. Further applications in health decision science are encouraged.
Highlights
The incidence of type 2 diabetes (T2D) has reached epidemic proportions globally, with an average of one person dying of diabetes every 8 s in the world [1]
We present a new version of the Taiwan Type 2 Diabetes Mellitus Holistic Care Model (T2DHoc), which could provide a well-elucidated estimation of the occurrence and time point of major diabetes-related complications over a patient’s lifetime
The patient disease pathways over ten years were collected as completely as possible to study the natural course of prolonged T2D complications and inconsistent fragmented data, and solely trace patients first enrolling P4P programme between 2002 and 2005 were excluded
Summary
The incidence of type 2 diabetes (T2D) has reached epidemic proportions globally, with an average of one person dying of diabetes every 8 s in the world [1]. Diabetes ranks fifth in the top ten causes of death among Taiwanese people, with diabetic patients frequently experiencing hypertension and hyperlipidaemia, which dramatically increase the risk of neuropathy, as well as microvascular and macrovascular complications [6]. Diabetes Health Education advises the treatment goals of glycated-heme control to be below 7%, blood pressure below 130/80 mmHg, and low-density cholesterol less than 100 mg/dL, to reduce the associated CVD burden. In Taiwan, there are approximately 2 million diabetic patients clinically at risk of diabetic complications. The Taiwan Diabetes Health Education Association has targeted nearly 6000 diabetes patients with glycosylated haemoglobin A1c (HbA1c) and blood pressure and cholesterol, the so-called ABC, to investigate indicators of complications of diabetes. The survey found that the total compliance rate in Taiwan patients with diabetes was 12.9%
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