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J Diabetes Complications. 2017 Jul;31(7):1158-1163. doi: 10.1016/j.jdiacomp.2017.04.004. Epub 2017 Apr 11.

Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

Author information

1
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO; Department of Medicine, University of Colorado Denver, Aurora, CO. Electronic address: Emily.x.schroeder@kp.org.
2
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
3
Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
4
HealthPartners Research Institute and HealthPartners Center for Chronic Care Innovation, Minneapolis, MN.
5
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO; Department of Medicine, University of Colorado Denver, Aurora, CO.

Abstract

AIMS:

To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes.

METHODS:

The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members. Variables were chosen that would be available in electronic health records. We developed 16-variable and 6-variable models, using a Cox counting model process that allows for the inclusion of multiple 6-month observation periods per person.

RESULTS:

Across the three cohorts, there were 850,992 6-month observation periods, and 10,448 periods with at least one severe hypoglycemic event. The six-variable model contained age, diabetes type, HgbA1c, eGFR, history of a hypoglycemic event in the prior year, and insulin use. Both prediction models performed well, with good calibration and c-statistics of 0.84 and 0.81 for the 16-variable and 6-variable models, respectively. In the external validation cohorts, the c-statistics were 0.80-0.84.

CONCLUSIONS:

We developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred.

KEYWORDS:

Diabetes mellitus; Electronic health records; Hypoglycemia; Prediction model; Risk factors

PMID:
28462891
PMCID:
PMC5516886
DOI:
10.1016/j.jdiacomp.2017.04.004
[Indexed for MEDLINE]
Free PMC Article

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