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Establishment and validation of a prediction model for ischemic stroke risks in patients with type 2 diabetes

  • Tsai-Chung Li
    Affiliations
    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan

    Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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  • Author Footnotes
    1 equally contributed as first authors.
    Hsiang-Chi Wang
    Footnotes
    1 equally contributed as first authors.
    Affiliations
    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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  • Chia-Ing Li
    Affiliations
    Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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  • Chiu-Shong Liu
    Affiliations
    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Wen-Yuan Lin
    Affiliations
    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Chih-Hsueh Lin
    Affiliations
    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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  • Sing-Yu Yang
    Affiliations
    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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  • Cheng-Chieh Lin
    Correspondence
    Corresponding author at: China Medical University, 91 Hsueh-Shih Road, Taichung 40421, Taiwan.
    Affiliations
    School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 equally contributed as first authors.
Published:February 17, 2018DOI:https://doi.org/10.1016/j.diabres.2018.01.034

      Highlights

      • This ischemic stroke risk predictive model is the first model established for Taiwanese patients with type 2 diabetes.
      • The risk prediction exhibited prediction accuracy and discriminatory ability.
      • The risk score is a useful screening tool for preventing ischemic stroke in Chinese patients with type 2 diabetes.

      Abstract

      Aims

      A risk scoring system for predicting ischemic stroke incidence may identify type 2 diabetes patients at high risk for ischemic stroke who can benefit from preventive intervention programs. Such a risk scoring system can serve as a benchmark to test novel putative risk factors.

      Methods

      The study adopted a retrospective cohort, including 28,124 Chinese patients with type 2 diabetes aged 30–84 years during 2001–2004. Participants were randomly assigned to the derivation and validation sets at a 2:1 ratio. Cox’s proportional hazard regression model was used to identify risk factors of ischemic stroke incidence in the derivation set. And then the steps proposed by the Framingham Heart Study for establishing an ischemic stroke prediction model with a scoring system was used.

      Results

      Among 9374 patients in the validation set, 1076 subjects (11.48%) developed ischemic stroke with a mean follow up period of 8.0 years. We identified the following risk factors: age, gender, smoking habit, duration of type 2 diabetes, blood pressure, HbA1c level, total cholesterol to high-density lipoprotein ratio, creatinine, fasting plasma glucose variation (FPG-CV), arterial embolism and thrombosis, diabetes retinopathy, hypoglycemia, anti-diabetes medication use, and cardiovascular medication. The area under receiver operating characteristic curve of the 3-year, 5-year, and 8-year ischemic stroke incidence risks were 0.72, 0.71, and 0.68 for the validation set, respectively.

      Conclusions

      This proposed ischemic stroke incidence risk prediction model is the first model established for Chinese patients with type 2 diabetes recruited from nationwide clinical settings.

      Keywords

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