High cardiovascular disease risk-associated with the incidence of Type 2 diabetes among prediabetics

BACKGROUND

Prediabetes is a risk factor for developing Type 2 diabetes mellitus (T2D). We report on the first cohort study of the association between high cardiovascular diseases (CVD) risk with the incidence of T2D in prediabetics. First, estimate the direct effect of developing T2D on patients with prediabetes who have high CVDs risk; and 2) assess the potential increased risk of developing T2D mediated by statins.

METHODS

We conducted a population-based cohort study using a subset of data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2000 to 2015. Cox proportional hazards (PH) regressions were conducted to estimate our primary outcome, which is the time to T2D among patients with prediabetes.

RESULTS

From the 4995 filtered prediabetic participants identified between 2000 and 2015, 2800 participants were diagnosed with high CVDs risk scores as measured by the Framingham risk score. 2195 participants were non-high CVDs risk controls. The covariate-adjusted hazard ratio (HR) of 1.24 [95% confidence interval (CI), 1.10-1.31] for T2D by CVDs risk among prediabetics was observed. The total effect of CVDs risk on developing T2D was decomposed to a natural direct effect of high CVDs risk HR= 1.18 [95% CI, 1.01-1.48] and an indirect effect through statin therapy of HR= 1.06 [95% CI, 0.97-1.30].

CONCLUSION

Patients with prediabetes and high CVDs risk had a 24% higher chance of developing T2D. The high CVDs risk effect was mediated by statin therapy. Regular monitoring and counselling of prediabetics using statins is likely warranted to prevent the incidence of T2D.

FIUS: Fixed partitioning undersampling method

BACKGROUND AND OBJECTIVE

In the medical field, data techniques for prediction and finding patterns of prevalent diseases are of increasing interest. Classification is one of the methods used to provide insight into predicting the future onset of type 2 diabetes of those at high risk of progression from pre-diabetes to diabetes. When applying classification techniques to real-world datasets, imbalanced class distribution has been one of the most significant limitations that leads to patients' misclassification. In this paper, we propose a novel balancing method to improve the prediction performance of type 2 diabetes mellitus in imbalanced electronic medical records (EMR).

METHODS

A novel undersampling method is proposed by utilizing a fixed partitioning distribution scheme in a regular grid. The proposed approach retains valuable information when balancing methods are applied to datasets.

RESULTS

The best AUC of 80% compared to other classifiers was obtained from the logistic regression (LR) classifier for EMR by applying our proposed undersampling method to balance the data. The new method improved the performance of the LR classifier compared to existing undersampling methods used in the balancing stage.

CONCLUSION

The results demonstrate the effectiveness and high performance of the proposed method for predicting diabetes in a Canadian imbalanced dataset. Our methodology can be used in other areas to overcome the limitations of imbalanced class distributions.