Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore

Division of Primary Care, Tower Building, University Park, Nottingham NG2 7RD.
BMJ (online) (Impact Factor: 16.38). 02/2009; 338:b880. DOI: 10.1136/bmj.b880
Source: PubMed

ABSTRACT To develop and validate a new diabetes risk algorithm (the QDScore) for estimating 10 year risk of acquiring diagnosed type 2 diabetes over a 10 year time period in an ethnically and socioeconomically diverse population.
Prospective open cohort study using routinely collected data from 355 general practices in England and Wales to develop the score and from 176 separate practices to validate the score.
2 540 753 patients aged 25-79 in the derivation cohort, who contributed 16 436 135 person years of observation and of whom 78 081 had an incident diagnosis of type 2 diabetes; 1 232 832 patients (7 643 037 person years) in the validation cohort, with 37 535 incident cases of type 2 diabetes.
A Cox proportional hazards model was used to estimate effects of risk factors in the derivation cohort and to derive a risk equation in men and women. The predictive variables examined and included in the final model were self assigned ethnicity, age, sex, body mass index, smoking status, family history of diabetes, Townsend deprivation score, treated hypertension, cardiovascular disease, and current use of corticosteroids; the outcome of interest was incident diabetes recorded in general practice records. Measures of calibration and discrimination were calculated in the validation cohort.
A fourfold to fivefold variation in risk of type 2 diabetes existed between different ethnic groups. Compared with the white reference group, the adjusted hazard ratio was 4.07 (95% confidence interval 3.24 to 5.11) for Bangladeshi women, 4.53 (3.67 to 5.59) for Bangladeshi men, 2.15 (1.84 to 2.52) for Pakistani women, and 2.54 (2.20 to 2.93) for Pakistani men. Pakistani and Bangladeshi men had significantly higher hazard ratios than Indian men. Black African men and Chinese women had an increased risk compared with the corresponding white reference group. In the validation dataset, the model explained 51.53% (95% confidence interval 50.90 to 52.16) of the variation in women and 48.16% (47.52 to 48.80) of that in men. The risk score showed good discrimination, with a D statistic of 2.11 (95% confidence interval 2.08 to 2.14) in women and 1.97 (1.95 to 2.00) in men. The model was well calibrated.
The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity. The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator (

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To derive and validate a set of clinical risk prediction algorithm to estimate the 10-year risk of 11 common cancers. Prospective open cohort study using routinely collected data from 753 QResearch general practices in England. We used 565 practices to develop the scores and 188 for validation. 4.96 million patients aged 25-84 years in the derivation cohort; 1.64 million in the validation cohort. Patients were free of the relevant cancer at baseline. Cox proportional hazards models in the derivation cohort to derive 10-year risk algorithms. Risk factors considered included age, ethnicity, deprivation, body mass index, smoking, alcohol, previous cancer diagnoses, family history of cancer, relevant comorbidities and medication. Measures of calibration and discrimination in the validation cohort. Incident cases of blood, breast, bowel, gastro-oesophageal, lung, oral, ovarian, pancreas, prostate, renal tract and uterine cancers. Cancers were recorded on any one of four linked data sources (general practitioner (GP), mortality, hospital or cancer records). We identified 228 241 incident cases during follow-up of the 11 types of cancer. Of these 25 444 were blood; 41 315 breast; 32 626 bowel, 12 808 gastro-oesophageal; 32 187 lung; 4811 oral; 6635 ovarian; 7119 pancreatic; 35 256 prostate; 23 091 renal tract; 6949 uterine cancers. The lung cancer algorithm had the best performance with an R(2) of 64.2%; D statistic of 2.74; receiver operating characteristic curve statistic of 0.91 in women. The sensitivity for the top 10% of women at highest risk of lung cancer was 67%. Performance of the algorithms in men was very similar to that for women. We have developed and validated a prediction models to quantify absolute risk of 11 common cancers. They can be used to identify patients at high risk of cancers for prevention or further assessment. The algorithms could be integrated into clinical computer systems and used to identify high-risk patients. There is a simple web calculator to implement the Qcancer 10 year risk algorithm together with the open source software for download (available at Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 03/2015; 5(3):e007825. DOI:10.1136/bmjopen-2015-007825 · 2.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The paper presents an iris aging analysis based on compar-ison results obtained for four different iris matchers. We collected an iris aging database of samples captured even eight years apart. To our best knowledge, this is the only database worldwide of iris images col-lected with such a large time distance between capture sessions. We evaluated the influence of the intra-vs. inter-session accuracy of the iris recognition, as well as the accuracy between the short term (up to two years) vs. long term comparisons (from 5 to 9 years). The average gen-uine scores revealed statistically significant differences with respect to the time distance between examined samples (up to 14 % of degradation in the average genuine scores is observed). These results may suggest that the iris pattern ages to some extent, and thus appropriate countermea-sures should be deployed in application assuming large time distances between iris template replacements (or adaptations).
    Communications in Computer and Information Science, Edited by Mireya Fernández-Chimeno, Pedro L. Fernandes, Sergio Alvarez, Deborah Stacey, Jordi Solé-Casals, Ana Fred, Hugo Gamboa, 11/2014: chapter Influence of Iris Template Aging on Recognition Reliability: pages 284-299; Springer Berlin Heidelberg., ISBN: 978-3-662-44484-9
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Context: Evidence suggests that the human skeleton might be involved in the regulation of glucose homeostasis. Objective: To investigate the effect of exposure to bisphosphonates on the risk of incident type 2 diabetes mellitus (T2DM). Design: Population-based, retrospective open cohort study over the period 1995 to 2010 Setting: The Health Improvement Network database (THIN) from UK primary care setting. Patients: 35,998 individuals aged over 60 years, without diabetes at baseline and with more than one year's exposure to bisphosphonates and 126,459 age, gender, BMI and general practice matched un-exposed individuals. Interventions: None Main outcome measure: A new diagnosis of T2DM during the 16-year long observation period, determined by Read codes and adjusted Incidence Rate Ratio (aIRR) in bisphosphonate exposed compared to unexposed groups. Results: The risk of incident T2DM was significantly lower in patients exposed to bisphosphonates compared to matched controls [aIRR=0.52, 95% confidence interval (CI): 0.48-0.56, p <0.0001]. In subgroup analyses, the findings remained consistent in males [0.77 (0.66-0.89)], females [0.49 (0.45-0.53)], obese [0.54 (0.50-0.59)], individuals exposed to steroid treatment [0.47 (0.34-0.64)], and over different types of bisphosphonate medication. Analysis of duration of treatment suggested a brief increase in the risk of T2DM (1 to 2.5 years of exposure), followed by a progressive, sustained decrease as the years of exposure accumulated. Conclusions: This observational evidence suggests exposure to bisphosphonates was associated with a significant 50% reduction in the risk of incident T2DM.
    Journal of Clinical Endocrinology &amp Metabolism 02/2015; 100(5):jc20143481. DOI:10.1210/jc.2014-3481 · 6.31 Impact Factor

Full-text (2 Sources)

Available from
May 20, 2014