OBJECTIVES: The CHIME (Chinese Hong Kong Integrated Modeling and Evaluation) model is an individual-level type 2 diabetes model to simulate lifetime health outcomes in East Asian populations using data up to 2017. We updated the CHIME model incorporating recent patient data to refit models for mortality, complications, and time-varying progression of biomarkers. Hemodialysis was added as a new model outcome.

METHODS: We updated the CHIME health outcome model using data from a population-based cohort of 96,360 individuals diagnosed with type 2 diabetes between 2013 to 2016 with follow-up until 2022 (mean follow-up: 5.9 years). For time to event outcomes, we tested exponential, Weibull, log-logistic, log-normal, Gompertz and logistic models with selection based on AIC. Equations were derived using parametric proportional hazard models except for mortality (logistic regression) and retinopathy (flexible parametric survival model). Biomarker progression models for glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol were derived using linear and logistic regression.

RESULTS: The updated CHIME2 simulation model comprised of 13 risk equations to predict mortality, microvascular, and macrovascular complications (myocardial infarction, ischemic heart disease, heart failure, cerebrovascular disease, peripheral vascular disease, neuropathy, amputation of lower limb, ulcer of skin, chronic kidney disease, retinopathy, and cataracts). The original CHIME model underestimated mortality. The improved CHIME2 model developed updated mortality and time-varying risk factors (biomarkers) risk equations.

CONCLUSIONS: The updated CHIME2 simulation model can be applied to assist health service planners and policymakers in decision-making, such as setting HbA1c, BMI, and lipid targets, to optimize health outcomes. Further validation is needed to assess the performance.