A new tool for treatment decision and health economic evaluation in type 1 diabetes: A patient-level model derived from a nationwide population

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A study recently published in Diabetes Care, led by Dr An Duy Tran and co-authored by Dr Josh Knight, Prof Andrew Palmer and Prof Philip Clarke, provides a comprehensive picture of the interdependencies between risk factors of type 1 diabetes-related complications and death, history of complications and future adverse events. These interdependencies were characterised by 13 equations predicting the risk of adverse events and 10 equations projecting risk factor progression, derived entirely from a nationwide longitudinal registry containing nearly 28,000 patients with type 1 diabetes in a 10-year follow-up period. These equations were integrated into a patient-level simulation model which underwent a rigorous face and internal validation.

For a patient with specific baseline risk factors, the simulation model can be used to estimate life expectancy and predict the occurrence of complications including heart attack, PCI, CABG, stroke, amputation, hyperglycaemia, hypoglycaemia, heart failure, peripheral vascular disease and end-stage kidney disease over the lifetime of the patient. When combined with costs and quality of life for the events, the model can serve as a tool for economic evaluation of new treatments for type 1 diabetes.

The complex interrelationships between risk factors, event histories and the occurrence of complications and death were summarized by Dr An Duy Tran in the diagram above (numbers represent hazard ratios). For more information, see the full paper.