![]() ![]() Internal validations studies found that BRAVO predicted outcomes from the ACCORD trial, including congestive heart failure, MI, stroke, angina, blindness, end-stage renal disease, and neuropathy. Fonseca said that BRAVO improves four aspects of diabetes risk prediction compared with other tools: It better captures the effects of body weight on cardiovascular risks, cost, and QALYs it better captures hypoglycemia it has a globalization module to calibrate regional variation of cardiovascular risks and it has both utility and QALY equations developed from the same study cohort. “Using left truncated regression, we can piece together the segmented follow-up times for 10,251 patients to a complete diabetes progression track from 0 years to 40 years after diabetes onset,” he said.ĭECLARE: Dapagliflozin improves some cardiovascular, renal outcomesĭr. In the ACCORD cohort, baseline duration varied from 0 to 35 years. 4% observed), end-stage renal disease (0.5% vs. 4% observed) yet it underpredicted congestive heart failure (2.2% vs. 4.9% observed), and all-cause mortality (10.3% vs. When he and his associates applied the UKPDS Risk Engine to the ACCORD cohort, they found that the UPKDS Risk Engine overpredicted the risk of stroke (2.3% vs. Fonseca, who is chief of the section of endocrinology at Tulane University Health Science Center, New Orleans. “There are lots of data now showing that if you get hypoglycemia, your risk of a cardiovascular event goes up greatly over the subsequent 2 years,” said Dr. The risk engine contains three modules for 17 equations in total, including angina, blindness, and hypoglycemia ( Pharmacoeconomics. The model predicts both primary and secondary CVD events, microvascular events, the progress of hemoglobin A 1c and other key biomarkers over time, quality-adjusted life-year (QALY) function decrements associated with complications, and an ability to predict outcomes in patients from other regions in the world. Fonseca, Hui Shao, PhD, and Lizheng Shi, PhD, have developed the Building, Relating, Assessing, Validating Outcomes (BRAVO) of Diabetes Model, a patient-level microsimulation model based on data from the ACCORD trial. That’s one of the big problems with the risk engines we’re using.” “Sometimes the results may not be generalizable. Fonseca, MD, said at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease. In conclusion, a significant proportion of CHD events in adults with T2DM could be prevented from composite control of risk factors often not at goal.“All these risk engines have various degrees of accuracy along with several limitations, including that they are derived from data from various populations,” Vivian A. Nominal risk factor control was projected to prevent 36% and 38% and aggressive control 51% and 61% of CHD events, respectively. Controlling all risk factors to goal was projected to prevent 35% and 45% of CHD events in men and women, respectively. Of 606 men (representing 6.2 million) and 603 women (6.3 million) with DM and no previous CHD, 1.3 million men and 0.7 million women would develop a CHD event within 10 years if left uncontrolled. We examined in all those not at goal the impact of statistical control of smoking, glycated hemoglobin, systolic blood pressure, and total and high-density lipoprotein cholesterol, according to the predefined criteria setting risk factors at different levels of control representing (1) “All to Goal,” (2) at “Nominal Control,” or (3) at “Aggressive Control.” Preventable CHD events represented the difference between the number of events estimated from the control of these risk factors versus current levels of the risk factors. Among US adults with diagnosed T2DM aged ≥30 years in the National Health and Nutrition Examination Survey 2007 to 2012, we assessed CHD events preventable using the United Kingdom Prospective Diabetes Study CHD risk engine. We examined the potential US population impact of single and composite risk factor control. Type 2 diabetes mellitus (T2DM) carries significant risks for coronary heart disease (CHD). ![]()
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