United Kingdom Prospective Diabetes Study Risk Engine Research Articles

Impact of metabolic surgery on 10-year cardiovascular disease risk in Chinese individuals with type 2 diabetes.

In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI). To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery. University hospital, China. We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m2 were compared with those with a BMI > 30 kg/m2. We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m2 and 55 (47%) had a BMI > 30 kg/m2. Patients with a BMI < 30 kg/m2 were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m2 was significantly lower than that in the group with BMIs > 30 kg/m2 (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine. The 10-year CVD risk in T2D patients with BMIs < 30 kg/m2 and BMIs > 30 kg/m2 were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m2 was lower than that in patients with BMIs > 30 kg/m2. The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery.

Diabetes Type 2 and Physical Activity Program: Potential Application of Risk-Engine UKPDS Score in Out-Patient Context

Diabetes mellitus Type 2 (DMT2) carries a high risk of cardiovascular (CV) morbidity and mortality. Physical activity (PA) is widely prescribed for this population. However, detection of the eventual risk level and the potential additional increase through physical exercise are of paramount importance in these patients. A model for predicting absolute risk for coronary artery disease in diabetes has been provided in the investigation by the UKPDS (United Kingdom Prospective Diabetes Study). The present study aims to verify the potential feasibility of the UKPDS calculation in an out-patient context, where patients with DMT2 can be selected for an exercise prescription program. All patients investigated were consecutively enrolled in the study at the time of the first clinical check-up in the outpatient center of the University of Perugia-Internal Medicine Department. A group of 101 Caucasian patients (62 males; 39 females; aged 67 ± 2 years) were studied. In agreement with the UKPDS score, gender, age, ethnicity, Body Mass Index, systolic blood pressure and smoking habits were considered. The global mean cardiovascular risk calculated by the UKPDS risk-engine was 25.8% of a first cardiovascular event within 10 years after the initial observation. Despite an absence of symptoms, the risk was globally high and in agreement with current literature. Conclusion: The data are suggestive of a potential large clinical application of UKPDS risk-engine score in an outpatient context, especially in those asymptomatic DMT2 patients potentially enrolled in a physical activity program. This pilot investigation supports the importance for immediate estimation of cardiovascular risk in DMT2 subjects to implement basic therapeutic strategies such as physical activity.

Impact of carotid atherosclerosis detection on physician and patient behavior in the management of type 2 diabetes mellitus: a prospective, observational, multicenter study.

BackgroundThis study compared carotid ultrasound (CUS) and traditional risk calculations in determining cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (DM) and investigated whether awareness of CVD affects patient and/or physician behavior.MethodsIn this prospective, observational, multicenter study, 797 participants with type 2 diabetes were assessed using CUS, the United Kingdom Prospective Diabetes Study Risk Engine (UKPDSRE) calculator, and the Framingham Risk Score (FRS) algorithm. Health-related behaviors and physician treatments were compared at baseline and at 6 months after assessment.ResultsAccording to CUS, 43.5 % of the participants were at high risk (compared to 10.6 % and 4.3 % using the UKPDSRE and FRS approaches, respectively). Interestingly, 31.5 % of the patients with low risk scores according to the UKPDSRE calculator and 35.8 % of the patients with low risk scores according to the FRS algorithm were found to be at high risk according to CUS. The proportion of patients who achieved target LDL-C levels significantly increased after CUS. Moreover, increased awareness of atherosclerosis through CUS findings significantly altered physician treatment patterns and patient health-related behaviors.ConclusionsCarotid atherosclerosis was detected in more than 30 % of all participants with low or intermediate risk stratification scores. Improved awareness of atherosclerosis through CUS findings had a positive impact on both patient and physician behavior, resulting in improved CV risk management.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0401-5) contains supplementary material, which is available to authorized users.

Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes.

Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries.

Serum C-peptide level as a predictor of atherosclerosis and cardiovascular disease in type 2 diabetes mellitus

Objective: To assess the correlation of serum C-peptide level to carotid intima media thickness (a surrogate marker of atherosclerosis) and risk of developing cardiovascular disease (CVD) in type 2 diabetes patients as determined by United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Materials and Methods: About 101 cases of diabetes mellitus (DM) type 2 (diagnosed according to American Diabetes Association 2007 criteria) were subjected to detail clinical examination and laboratory investigations. The intima media thickness of both carotid arteries (CIMT) was measured for each patient with color Doppler. The risk of CVD was calculated using UKPDS risk engine. Observations: Age of subjects, glycated hemoglobin (HbA1c), body mass index (BMI), levels of systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-DL (LDL), homocysteine, CIMT, and the 10 years CVD risk according to the UKPDS were significantly different across the C-peptide quartiles (P for trend <0.05). Significant positive correlations of C-peptide levels were found with age of subjects, duration of DM, BMI, fasting plasma glucose, HbA1c, SBP, TC, TG, LDL, and homocysteine. Significant negative correlation of C-peptide levels was observed with HDL. C-peptide levels had significant positive correlation with CIMT (atherosclerosis) and 10 years CVD risk (future CVD) by UKPDS risk engine. Conclusions: Serum C-peptide level seems to be significantly related to the development of atherosclerosis and future CVD in type 2 DM. It may be used as a predictor of subclinical atherosclerosis and CVD in these patients.

Realization of a service for the long-term risk assessment of diabetes-related complications

AimWe present a computerized system for the assessment of the long-term risk of developing diabetes-related complications. MethodsThe core of the system consists of a set of predictive models, developed through a data-mining/machine-learning approach, which are able to evaluate individual patient profiles and provide personalized risk assessments. Missing data is a common issue in (electronic) patient records, thus the models are paired with a module for the intelligent management of missing information. ResultsThe system has been deployed and made publicly available as Web service, and it has been fully integrated within the diabetes-management platform developed by the European project REACTION. Preliminary usability tests showed that the clinicians judged the models useful for risk assessment and for communicating the risk to the patient. Furthermore, the system performs as well as the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine when both systems are tested on an independent cohort of UK diabetes patients. ConclusionsOur work provides a working example of risk-stratification tool that is (a) specific for diabetes patients, (b) able to handle several different diabetes related complications, (c) performing as well as the widely known UKPDS Risk Engine on an external validation cohort.

Commentary on the United Kingdom Prospective Diabetes Study outcomes model 2: Need for long-term follow up and quality of life data in Asian patients.

Commentary on the United Kingdom Prospective Diabetes Study outcomes model 2: Need for long-term follow up and quality of life data in Asian patients.

Cardiovascular Risk Assessment with Vascular Function, Carotid Atherosclerosis and the UKPDS Risk Engine in Korean Patients with Newly Diagnosed Type 2 Diabetes

BackgroundPatients with type 2 diabetes have an increased risk of cardiovascular disease. Few studies have evaluated the cardiovascular disease (CVD) risk simultaneously using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine and non-invasive vascular tests in patients with newly diagnosed type 2 diabetes.MethodsParticipants (n=380; aged 20 to 81 years) with newly diagnosed type 2 diabetes were free of clinical evidence of CVD. The 10-year coronary heart disease (CHD) and stroke risks were calculated for each patient using the UKPDS risk engine. Carotid intima media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AI) were measured. The correlations between the UKPDS risk engine and the non-invasive vascular tests were assessed using partial correlation analysis, after adjusting for age, and multiple regression analysis.ResultsThe mean 10-year CHD and 10-year stroke risks were 14.92±11.53% and 4.03±3.95%, respectively. The 10-year CHD risk correlated with CIMT (P<0.001), FMD (P=0.017), and PWV (P=0.35) after adjusting for age. The 10-year stroke risk correlated only with the mean CIMT (P<0.001) after adjusting for age. FMD correlated with age (P<0.01) and systolic blood pressure (P=0.09). CIMT correlated with age (P<0.01), HbA1c (P=0.05), and gender (P<0.01).ConclusionThe CVD risk is increased at the onset of type 2 diabetes. CIMT, FMD, and PWV along with the UKPDS risk engine should be considered to evaluate cardiovascular disease risk in patients with newly diagnosed type 2 diabetes.

Comparison of the Framingham Risk Score, UKPDS Risk Engine, and SCORE for Predicting Carotid Atherosclerosis and Peripheral Arterial Disease in Korean Type 2 Diabetic Patients

BackgroundTo compare the predictability of the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and the Systematic Coronary Risk Evaluation (SCORE) for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients.MethodsAmong 1,275 registered type 2 diabetes patients in the health center, 621 subjects with type 2 diabetes participated in the study. Well-trained examiners measured the carotid intima-media thickness (IMT), carotid plaque, and ankle brachial index (ABI). The subject's 10-year risk of coronary heart disease was calculated according to the FRS, UKPDS, and SCORE risk scores. These three risk scores were compared to the areas under the curve (AUC).ResultsThe odds ratios (ORs) of all risk scores increased as the quartiles increased for plaque, IMT, and ABI. For plaque and IMT, the UKPDS risk score provided the highest OR (95% confidence interval) at 3.82 (2.36, 6.17) and at 6.21 (3.37, 11.45). For ABI, the SCORE risk estimation provided the highest OR at 7.41 (3.20, 17.18). However, no significant difference was detected for plaque, IMT, or ABI (P = 0.839, 0.313, and 0.113, respectively) when the AUCs of the three risk scores were compared. When we graphed the Kernel density distribution of these three risk scores, UKPDS had a higher distribution than FRS and SCORE.ConclusionNo significant difference was observed when comparing the predictability of the FRS, UKPDS risk engine, and SCORE risk estimation for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients.

Recalculation of cardiovascular risk score as a surrogate marker of change in clinical care of diabetes patients: the Alphabet POEM project (Practice Of Evidence-based Medicine)

SUMMARYAims: To assess the impact of evidence-based strategies on the care of subjects with diabetes, in particular on their coronary heart disease (CHD) risk, using the Alphabet Strategy template and coronary heart disease (CHD) risk calculators as novel audit tools.Methods: Diabetes and cardiovascular parameters were collected on 400 consecutive type 2 diabetes patients attending the outpatient clinic. The subjects were men and women aged 21-75 years with necessary follow-up data from referral or first chronological available letter in the notes (T0) to the most recent follow-up visit (Tfu). The average follow-up period was 5 years. Absolute CHD risk was calculated using the Framingham risk function and the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. The results were analysed using Student's paired t-test and chi-squared test.Results (T0 vs.Tfu): Advice: smoking status improved 18.3 vs. 15.5%: p = 0.3. Blood pressure: systolic blood pressure improved 145.8 ± 21.1 vs. 140.1 ± 20.5mmHg: p < 0.0001. Diastolic blood pressure improved 82.0 ± 12.2 vs. 76.5 ± 11.0mmHg: p < 0.0001. Cholesterol: total cholesterol improved 5.8 ± 1.6 vs. 4.9 ± 1.0 mmol/L: p < 0.0001; high density lipoprotein (HDL) cholesterol improved 1.05 vs. 1.26 mmol/L: p < 0.001. Diabetes control: glycated haemoglobin (HbA1c)% worsened 7.9 ± 1.8 vs. 8.1 ± 1.5: p < 0.0001. However, when adjusted for duration of diabetes, this improved non-significantly by 12% overall. Eye examination: improved 86.5 vs. 97.5%: p < 0.001. Feet examination: improved 69.8 vs. 83.5%: p < 0.001. Guardian drugs: significantly more patients were on aspirin (29.0 vs. 83.5%: p < 0.001), angiotensin converting enzyme (ACE) inhibitors (32.0 vs. 64.5%: p < 0.001), and lipid lowering therapy (16.8 vs. 55.0%: p < 0.001). Heart disease risk scores: a significant reduction in Framingham 10-year absolute cardiac risk was achieved (20.6 ± 10.04% vs. 16.7 ± 9.1%: p = 0.001). Using the UKPDS risk engine, there was a non-significant reduction in absolute CHD risk over the follow-up period (23.8 ± 14.8% vs. 23.7 ± 15.5: p = NS). There were significant improvements between age-adjusted risk score (Tadj) and follow-up values (Tfu) (Framingham: 23.67% (Tadj) vs. 16.7% (Tfu); UKPDS 31.2% (Tadj) vs. 23.7% (Tfu)). For UKPDS stroke risk, a significant improvement was seen from Tadj to Tfu (19.0% (Tadj) vs. 16.4% (Tfu): p < 0.001), with a significant deterioration noted between T0 and Tfu (11.5% (T0) vs. 16.4% (Tfu): p < 0.0001).Conclusions:The Alphabet Strategy is a novel evidence-based approach to clinical diabetes care, which produced a statistically significant improvement in most of the assessed parameters. The Alphabet Practice Of Evidence-based Medicine (POEM) template is a useful clinical tool for diabetes care and audit. It includes most of the components of diabetes audit required by the National Service Framework (NSF) and the United Kingdom GP contract.