Original article
An Electronic Health Record–Compatible Model to Predict Personalized Treatment Effects From the Diabetes Prevention Program: A Cross-Evidence Synthesis Approach Using Clinical Trial and Real-World Data

https://doi.org/10.1016/j.mayocp.2021.09.012Get rights and content
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Abstract

Objective

To develop an electronic health record (EHR)-based risk tool that provides point-of-care estimates of diabetes risk to support targeting interventions to patients most likely to benefit.

Patients and Methods

A risk prediction model was developed and validated in a large observational database of patients with an index visit date between January 1, 2012, and December 31, 2016, with treatment effect estimates from risk-based reanalysis of clinical trial data. The risk model development cohort included 1.1 million patients with prediabetes from the OptumLabs Data Warehouse (OLDW); the validation cohort included a distinct sample of 1.1 million patients in OLDW. The randomly assigned clinical trial cohort included 3081 people from the Diabetes Prevention Program (DPP) study.

Results

Eleven variables reliably obtainable from the EHR were used to predict diabetes risk. This model validated well in the OLDW (C statistic = 0.76; observed 3-year diabetes rate was 1.8% (95% confidence interval [CI], 1.7 to 1.9) in the lowest-risk quarter and 19.6% (19.4 to 19.8) in the highest-risk quarter). In the DPP, the hazard ratio (HR) for lifestyle modification was constant across all levels of risk (HR, 0.43; 95% CI, 0.35 to 0.53), whereas the HR for metformin was highly risk dependent (HR, 1.1; 95% CI, 0.61 to 2.0 in the lowest-risk quarter vs HR, 0.45; 95% CI, 0.35 to 0.59 in the highest-risk quarter). Fifty-three percent of the benefits of population-wide dissemination of the DPP lifestyle modification and 73% of the benefits of population-wide metformin therapy can be obtained by targeting the highest-risk quarter of patients.

Conclusion

The Tufts–Predictive Analytics and Comparative Effectiveness DPP Risk model is an EHR-compatible tool that might support targeted diabetes prevention to more efficiently realize the benefits of the DPP interventions.

Abbreviations and Acronyms

AA
Black/African American
ADA
American Diabetes Association
BMI
body mass index
DPP
Diabetes Prevention Program
EHR
electronic health record
FG
fasting glucose
HbA1c
hemoglobin A1c
HDL
high-density lipoprotein
HR
hazard ratio
HTN
hypertension
IRB
institutional review board
OLDW
OptumLabs Data Warehouse

Cited by (0)

Grant Support: This work was supported by a Patient-Centered Outcomes Research Institute contract (DI-1604-35234). The funder had no role in the conduct of this research or the decision to publish the results.

Potential Competing Interests: The authors report no competing interests.

Data Previously Presented: A preliminary report of this work was previously published on medRxiv on January 8, 2021. https://doi.org/10.1101/2021.01.06.21249334