Risk prediction models for type 2 diabetes using either fasting plasma glucose or HbA1c in Chinese, Malay, and Indians: Results from three multi-ethnic Singapore cohorts

Jowy Yi Seah, Centre for Population Health Research and Implementation, SingHealth, Singapore 150167, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Jiali Yao, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Yueheng Hong, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Charlie Guan Lim, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Charumathi Sabanayagam, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore.
Simon Nusinovici, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
Daphne Su-Lyn Gardner, Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore.
Marie Loh, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; Research Division, National Skin Centre, Singapore 308205, Singapore.
Falk Müller-Riemenschneider, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Chuen Seng Tan, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
Khung Keong Yeo, Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; Duke-NUS Medical School, Singapore.
Tien Yin Wong, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore.
Ching-Yu Cheng, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore; Center for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore.
Stefan Ma, Epidemiology & Disease Control Division, Ministry of Health, Singapore 169854, Singapore.
E Shyong Tai, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore.
John C. Chambers, Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom.
Rob M. van Dam, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, United States. Electronic address: rvandam@gwu.edu.
Xueling Sim, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore. Electronic address: ephsx@nus.edu.sg.

Document Type

Journal Article

Publication Date

8-15-2023

Journal

Diabetes research and clinical practice

Volume

203

DOI

10.1016/j.diabres.2023.110878

Keywords

Discrimination; Logistic regression; Prospective cohorts; Recalibration; Risk prediction models; Type 2 diabetes

Abstract

AIMS: To assess three well-established type 2 diabetes (T2D) risk prediction models based on fasting plasma glucose (FPG) in Chinese, Malays, and Indians, and to develop simplified risk models based on either FPG or HbA1c. METHODS: We used a prospective multiethnic Singapore cohort to evaluate the established models and develop simplified models. 6,217 participants without T2D at baseline were included, with an average follow-up duration of 8.3 years. The simplified risk models were validated in two independent multiethnic Singapore cohorts (N = 12,720). RESULTS: The established risk models had moderate-to-good discrimination (area under the receiver operating characteristic curves, AUCs 0.762 - 0.828) but a lack of fit (P-values < 0.05). Simplified risk models that included fewer predictors (age, BMI, systolic blood pressure, triglycerides, and HbA1c or FPG) showed good discrimination in all cohorts (AUCs ≥ 0.810), and sufficiently captured differences between the ethnic groups. While recalibration improved fit the simplified models in validation cohorts, there remained evidence of miscalibration in Chinese (p ≤ 0.012). CONCLUSIONS: Simplified risk models including HbA1c or FPG had good discrimination in predicting incidence of T2D in three major Asian ethnic groups. Risk functions with HbA1c performed as well as those with FPG.

Department

Exercise and Nutrition Sciences

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