The American Diabetes Association's 57th Annual Advanced Postgraduate Course

Abstract

The American Diabetes Aassociation's 57th Annual Advanced Postgraduate Course was held 5–7 February 2010 in San Francisco, California. Free webcasts of the talks from the 57th Annual Advanced Postgraduate Course are available at http://professional.diabetes.org/pg10. ### Risk prediction in diabetes Michael Stern (San Antonio, TX) discussed risk prediction in diabetes, addressing the use of biomarkers and approaches with risk calculation engines. In general, he noted, the state of wellness is inherently asymptomatic without functional impairments, and many individual with diagnosed diabetes, hypertension, and even with cardiovascular disease (CVD) are “well.” For these individuals, treatment provides no current benefit but only the promise of a future benefit, which may never come to pass. If a well person in this sense cannot be made better, Stern pointed out that we must be particularly cognizant of the dictum ascribed to Niels Bohr: “Prediction is very difficult, especially about the future.” A tool used in analysis of tests is the calculation of the area under the curve (AUC) of the receiver-operating characteristic graph of sensitivity versus (1-specificity). The AUC can be interpreted to equal the likelihood that a person destined to develop the disease or characteristic being tested for has a higher score, comparing one person who is with another who is not going to develop the given outcome (1). The AUC should be contrasted with an odds ratio (OR) or relative risk, which may be calculated as equaling (sensitivity) × (1 − false positive rate)/[(1 − sensitivity) × (false positive rate)]. This may better be thought of as pertaining to populations, with an OR of 1.5–3.0 giving rise to AUCs of 0.57–0.68, which Stern termed not terribly impressive levels, as can be observed in the overlap of distribution curves of those developing versus not developing the disease or characteristic. An OR of 10 is needed to give a …