Internal Validation of the Metabo-Reno-Cardiovascular Disease Model: Mortality in Type 2 Diabetes

OBJECTIVES: Several generic disease models have been developed in cardiovascular disease (CVD), diabetes, obesity and kidney disease. These diseases have common comorbidities; thus, most of these models describe all of them to some extent, with some limitations. To the best of our knowledge, the metabo-reno-cardiovascular-disease-model (MRCDM) is the first model that fully integrates the impact of changes in all the appropriate risk factors on the different diseases, depending on the glycemic status and body weight. The aim of this abstract was to validate the prediction of mortality in individuals with type 2 diabetes.

METHODS: The MRCDM is a patient-based model. Individuals that enter the model can be with or without diabetes (type 1 or 2), obesity (defined by BMI), CVD and chronic kidney disease. To predict mortality in Western countries, 2 approaches can be used: UKPDS82 mortality equations or disease specific mortality (case and long-term fatality) combined with non-specific general mortality. The model was populated with UKPDS specific baseline characteristics (age 53; HbA1c 7.1%). The UKPDS90 progression of risk factors equations were used. CVD risk was predicted using UKPDS82, Framingham and the Swedish National Diabetes Registry (SweNDR) risk equations. Life-expectancy (LE), predicted with the different approaches, was compared to the UKPDS study outcomes.

RESULTS: In the UKPDS study, LE was 23.0 years. The MRCDM, applying UKPDS82 mortality equations and UKPDS82, Framingham and SweNDR, as CVD equations, predicts a LE of 22.6, 23.6 and 21.8 years, respectively. Applying the disease specific mortality approach and UKPDS82, Framingham and SweNDR, as CVD equations, results in a LE of 26.2, 26.6 and 25.9 years, respectively.

CONCLUSIONS: The MRCDM provides similar LE predictions to the UKPDS study. Whereas the disease specific mortality approach (based on recent case fatality general mortality data) results in higher LE due to improvements in patients’ clinical management, particularly in CVD.