A simple new risk assessment score that will allow GPs to accurately predict which of their patients are most likely to develop diabetes over the next 10 years has been developed by experts at The University of Nottingham.
A validation study of the QDScore diabetes risk algorithm, published in the British Medical Journal, has shown that it is highly accurate at identifying patients most under threat and is the first algorithm to take the patient’s ethnicity and socio-economic status into account as potential risk factors.
The score will allow doctors to decide which patients need testing for the disease or could benefit from medication and/or lifestyle advice on issues such as diet and exercise that could help prevent its onset and associated serious complications, including kidney failure, blindness, heart disease, leg ulcers and amputations.
The score, developed in collaboration with researchers at the universities of Edinburgh and Queen Mary’s and NHS Bristol, does not require laboratory tests, so can be used in routine clinical practice, by national screening programmes and by the general public via a web-based calculator at www.qdscore.org
Leading the development of the algorithm, Professor Julia Hippisley-Cox, of the University’s Division of Primary Care, said: “There is good evidence that lifestyle changes and medical intervention at an early stage can prevent type 2 diabetes in up to two-thirds of high-risk cases and that early diagnosis is likely to improve outcomes. As the number of people diagnosed with diabetes in the UK continues to rise, this new algorithm will be an invaluable tool to help doctors identify those at greatest risk who are most likely to benefit from interventions. ”
The new score was developed using data from the records of more than 2.5 million patients at 355 general practices across England and Wales, through the QResearch® database — a large validated primary care electronic database containing the health records of 11 million people from 551 general practices using the Egton Medical Information System (EMIS) computer system.
It took into account information on their ethnicity, age, sex, body mass index (BMI), smoking status, family history of diabetes, socio-economic status and medical history of high blood pressure, cardiovascular disease or use of corticosteroids to predict the probability of their developing diabetes and then followed their records through a 10-year period to find out who actually went on to be diagnosed with the illness.
The researchers found large variations in the risk of type 2 diabetes between different ethnic groups. Bangladeshi men and women were four times more likely to develop diabetes than white men and women, while Pakistani men and women were twice as likely to develop diabetes than white men and women.
They also found a marked difference in rates of type 2 diabetes by social deprivation, with women in the most deprived fifth more than twice as likely to develop diabetes than compared with the most affluent fifth. A similar, but less steep gradient was seen for men.
A further validation study, which confirmed the score offered reliable performance, was carried out on the records of more than 1.2 million patients with 37,000 new cases of type 2 diabetes.
The QDScore also performed well when compared to another diabetes risk algorithm known as the Cambridge Score.
The algorithm is already accessible on the internet for patients to use themselves by answering a series of simple questions on their medical health (http://www.qdscore.org) Software will also be made available to companies which provide clinical computer systems in the NHS through the medical software company ClinRisk Ltd.
The QDScore has been designed to support Government plans to implement a systematic and integrated programme of vascular risk and management for people aged between 40 and 74. This involves assessing people’s risk of cardiovascular disease, diabetes and chronic kidney disease and offering a tailored package of prevention. Costing around £250 million to implement, it is estimated that each year it could cut heart attacks and strokes by 9,500, prevent 2,000 deaths and reduce the number of people developing diabetes by 4,000. It will also reduce the financial burden placed on the NHS by the current demands for treatment for these diseases.
The QDScore for diabetes follows the recent introduction for clinical use of the QRisk®2 (http://www.qrisk.org) for estimating the risk of cardiovascular disease in patients, also developed as a result of research using the QResearch® database.
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Notes to editors:
QResearch® is one of the world’s largest primary care databases, containing anonymised data from over 11 million patients across England and Wales. New data is uploaded every night from the 551 EMIS general practices that participate in the project. More information is available on the web at www.qresearch.org
The University of Nottingham is ranked in the UK's Top 10 and the World's Top 100 universities by the Shanghai Jiao Tong (SJTU) and Times Higher (THE) World University Rankings.
More than 90 per cent of research at The University of Nottingham is of international quality, according to RAE 2008, with almost 60 per cent of all research defined as ‘world-leading’ or ‘internationally excellent’. Research Fortnight analysis of RAE 2008 ranks the University 7th in the UK by research power. In 27 subject areas, the University features in the UK Top Ten, with 14 of those in the Top Five.
The University provides innovative and top quality teaching, undertakes world-changing research, and attracts talented staff and students from 150 nations. Described by The Times as Britain's ‘only truly global university’, it has invested continuously in award-winning campuses in the United Kingdom, China and Malaysia. Twice since 2003 its research and teaching academics have won Nobel Prizes. The University has won the Queen's Award for Enterprise in both 2006 (International Trade) and 2007 (Innovation — School of Pharmacy), and was named ‘Entrepreneurial University of the Year’ at the Times Higher Education Awards 2008.