Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: the Basque Country Prospective Complications and Mortality Study risk engine (BASCORE).

AIMS/HYPOTHESIS: The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed. METHODS: We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed. RESULTS: The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno's C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk. CONCLUSIONS/INTERPRETATION: This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.

Duration of diabetes and screening coverage for retinopathy among patients with type 2 diabetes.

AIMS: Despite reporting of the Wisconsin Epidemiologic Study of Diabetic Retinopathy(1) and the Diabetic Retinopathy Awareness Program(2) that diabetes duration was a significant predictor for adherence to vision care guidelines, reports of estimates of screening coverage for diabetic retinopathy taking into account diabetes duration have been lagging. This article estimates considering diabetes duration, the prevalence of diabetic retinopathy and screening coverage for diabetic retinopathy among type 2 diabetic patients. METHODS: As part of a treatment program at a High-Resolution Diabetes Center in Spain, type 2 diabetic patients attending the center from January 2003 to January 2005 were invited to participate in the study. Data on age, sex, and diabetes were recorded into a questionnaire, as was information about previous eye examinations. Polaroid(R) photographs were taken of the eye fundus with the poorest visual acuity using a nonmydriatic retinal camera. RESULTS: A total of 217 type 2 diabetic patients entered the program. The average age and duration of diabetes was 60.9 years and 7 years, respectively. Screening coverage for diabetic retinopathy was higher in those with a longer duration of diabetes (chi(2) = 36.5; p = 0.001). Fifty percent of patients had developed some retinopathy within the first 5 years after the diagnosis of the disease, but only 26.1% had received a previous fundus examination. CONCLUSIONS: These results argue for screening programs for people with type 2 diabetes mellitus focused on the subgroup of patients with diabetes duration of 5 years or less.

External validation of a risk assessment model to adjust the frequency of eye-screening visits in patients with diabetes mellitus.

AIMS: To validate a sight-threatening diabetic retinopathy (STDR) risk assessment model to adjust the frequency of eye-screening visits in patients with diabetes mellitus. METHODS: Retrospective follow-up study of patients with diabetes mellitus attending a diabetes center. Anonimyzed data on gender, type and duration of diabetes, HbA1c, blood pressure and the presence and grade of diabetic retinopathy were gathered to estimate risk for STDR for each individual's worse eye over time by means of a prediction model. Receiver operating characteristics (ROC) analysis was performed to determine the diagnostic ability of the model, and a calibration graph was done to see the model fit. RESULTS: 508 screening intervals were analyzed, median diabetes duration was 10years, 87% were type 2 diabetes mellitus, and 3.1% developed STDR before the next screening visit. The area under the ROC curve was 0.74, and the calibration graph showed that model had a good fit. The reduction in screening frequency was 40% compared with fixed annual screening. CONCLUSIONS: Current prediction model used to estimate the risk of developing STDR in patients with diabetes performed well. A personalized screening frequency for diabetic retinopathy could be implemented in practice.

Escalas de cálculo del riesgo cardiovascular para pacientes con diabetes. ¿Qué son y de qué nos sirven? / Cardiovascular risk scores in patients with diabetes. What are they and what are they worth?

La enfermedad cardiovascular (ECV) representa la primera causa de mortalidad en las personas con diabetes mellitus, entre las cuales, el riesgo de mortalidad cardiovascular es 2-4 veces mayor que el de la población general. Las guías de práctica clínica recomiendan calcular el riesgo de ECV en la diabetes; sin embargo, se han desarrollado pocos modelos para estimar este riesgo en las personas con diabetes. Los primeros modelos de predicción de ECV en la diabetes mellitus tipo 2, que incluyeron junto a las variables de riesgo clásicas la HbA1c y los años de evolución, no son contemporáneos y no funcionan en poblaciones diferentes a las que participaron en su desarrollo. La creación de modelos de riesgo propios actuales y validados en diferentes poblaciones permitiría realizar intervenciones preventivas más agresivas y tempranas, y centradas en el paciente, con la finalidad de frenar la epidemia de ECV que padecen las personas con diabetes

Cardiovascular disease (CVD) remains the first cause of death in patients with diabetes mellitus. Cardiovascular mortality is between 2 and 4 times as high as the risk of matched controls in the general population. Although practice guidelines recommend calculating CVD risk in diabetes, few models for estimating cardiovascular risk have been developed specifically for diabetic patients. The first ones, taking into account HbA1c and diabetes duration plus classical risk factors, is not contemporary and perform sub-optimally in different populations with diabetes. Constructing updated population-derived and externally validated cardiovascular risk models will yield more aggressive patient-centered preventive interventions to curb the ongoing epidemic of CVD in patients with diabetes

Lanreotide Autogel for persistent diabetic macular edema.

Diffuse diabetic macular edema is usually refractory to conventional treatment. We investigated the effectiveness of a new prolonged lanreotide formulation in patients with bad-controlled diabetes and persistent cystoid macular edema. Our findings suggest that monthly subcutaneous injections of lanreotide Autogel offered an effective treatment alternative in these patients.