Projecting Long-Term Diabetes Complications through a BRAVO-Based Mock Simulation for Promoting Diabetes Prevention Program (DPP)

Abstract

Correctly understanding consequences of diabetes is essential for motivating prediabetic patients to join the diabetes prevention program (DPP). The overall population estimates on diabetes complications may be lower than individual’s risk estimates which are subjective to their life expectancy. This study using a newly developed diabetes model aimed to project major diabetes complications, conditioning on a range of survival lengths. 2011-2016 National Health and Nutrition Examination Survey data were used to generate a nationally representative sample of newly diagnosed diabetes patients. The Building, Relating, Validating, Acting and Validating Outcomes (BRAVO) diabetes simulation model was used to project the long-term risks of diabetes complications for the NHANES sample. The cohort of simulated patients were followed up for 20/40 years, conditioning on zero mortality (i.e., mock simulation experiment) and cumulative incidence during the follow-up periods for each complication were recorded. The average age of newly diagnosed diabetes was 51.66 y. For diabetes patients who have survived for 20 years after diabetes onset, the probabilities for diabetes complications were: MI (20.4%), stroke (7.8%), congestive heart failure (CHF, 10.6%), angina (13.4%), revascularization surgery (RS, 54.4%), end-stage renal disease (ESRD, 11.7%), severe pressure sensation loss (SPSL, 56.6%), and blindness (27%). For diabetes patients who have survived for 40 years after diabetes onset, the probabilities of diabetes complications were: MI (55.8%), stroke (24.3%), CHF (46.1%), angina (34.4%), RS (85.8%), ESRD (31.7%), SPSL (86.9%), blindness (64.9%). The presentation of diabetes complications for a long survival time could help prediabetes patients better assess diabetes impact on health. The BRAVO-base decision support simulation could serve as a tool to educate prediabetes population on benefits of diabetes prevention program. Disclosure H. Shao: None. S. Yang: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. X. Ji: None. L. Shi: None.