A competing-risk-based score for predicting twenty-year risk of incident diabetes: the Beijing Longitudinal Study of Ageing study

Few risk tools have been proposed to quantify the long-term risk of diabetes among middle-aged and elderly individuals in China. The present study aimed to develop a risk tool to estimate the 20-year risk of developing diabetes while incorporating competing risks. A three-stage stratification random-clustering sampling procedure was conducted to ensure the representativeness of the Beijing elderly. We prospectively followed 1857 community residents aged 55 years and above who were free of diabetes at baseline examination. Sub-distribution hazards models were used to adjust for the competing risks of non-diabetes death. The cumulative incidence function of twenty-year diabetes event rates was 11.60% after adjusting for the competing risks of non-diabetes death. Age, body mass index, fasting plasma glucose, health status, and physical activity were selected to form the score. The area under the ROC curve (AUC) was 0.76 (95% Confidence Interval: 0.72-0.80), and the optimism-corrected AUC was 0.78 (95% Confidence Interval: 0.69-0.87) after internal validation by bootstrapping. The calibration plot showed that the actual diabetes risk was similar to the predicted risk. The cut-off value of the risk score was 19 points, marking mark the difference between low-risk and high-risk patients, which exhibited a sensitivity of 0.74 and specificity of 0.65.