Use of the progression of adapted Diabetes Complications Severity Index to predict acute coronary syndrome, ischemic stroke, and mortality in Asian patients with type 2 diabetes mellitus: A nationwide cohort investigation

BACKGROUND: We report on a retrospective population study aimed at identifying and validating the progression of adapted Diabetes Complications Severity Index (DCSI) for acute coronary syndrome (ACS), ischemic stroke, and mortality in Asian people with type 2 diabetes mellitus (DM). METHODS: Utilizing a Taiwanese national dataset, we included 84 450 type 2 diabetic individuals between 2000 and 2011. The area under the receiver operating characteristic curve (C statistics of logistic model) and the C statistics of the Cox model were used to evaluate whether the progression of diabetic complication status could be a predictor of ACS, ischemic stroke, and death. The optimum threshold for adverse outcomes risk stratification were obtained using Youden's J statistic as the cutoff that gives the highest threshold. RESULTS: Among the study patients, the C statistics of the logistic model of the progression of the score predictive of ACS, ischemic stroke, and death were 0.72 (95% confidence interval [CI]: 0.71-0.73), 0.84 (95% CI: 0.84-0.85), and 0.66 (95% CI: 0.65-0.67), respectively. The progression of adapted DCSI had moderate discrimination for ACS, ischemic stroke, and death (C statistics = 0.71, 0.72, and 0.75, respectively) based on Cox regression analysis (Harrell C). The optimum threshold of the progression of the score for ACS, ischemic stroke, and death in type 2 DM patients were 0.30, 0.36, and 0.39, respectively. CONCLUSIONS: The acceptable discriminative power of the progression of adapted DCSI for Asian people affected by type 2 DM was demonstrated in a large cohort in Taiwan.