Comparisons of polyexposure, polygenic, and clinical risk scores in risk prediction of type 2 diabetes
File(s)T2D Predictive Accuracy_IT.docx (821.68 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE: To establish a polyexposure score (PXS) for type 2 diabetes (T2D) incorporating 12 nongenetic exposures and examine whether a PXS and/or a polygenic risk score (PGS) improves diabetes prediction beyond traditional clinical risk factors. RESEARCH DESIGN AND METHODS: We identified 356,621 unrelated individuals from the UK Biobank of White British ancestry with no prior diagnosis of T2D and normal HbA1c levels. Using self-reported and hospital admission information, we deployed a machine learning procedure to select the most predictive and robust factors out of 111 nongenetically ascertained exposure and lifestyle variables for the PXS in prospective T2D. We computed the clinical risk score (CRS) and PGS by taking a weighted sum of eight established clinical risk factors and >6 million single nucleotide polymorphisms, respectively. RESULTS: In the study population, 7,513 had incident T2D. The C-statistics for the PGS, PXS, and CRS models were 0.709, 0.762, and 0.839, respectively. Individuals in the top 10% of PGS, PXS, and CRS had 2.00-, 5.90-, and 9.97-fold greater risk, respectively, compared to the remaining population. Addition of PGS and PXS to CRS improved T2D classification accuracy, with a continuous net reclassification index of 15.2% and 30.1% for cases, respectively, and 7.3% and 16.9% for controls, respectively. CONCLUSIONS: For T2D, the PXS provides modest incremental predictive value over established clinical risk factors. However, the concept of PXS merits further consideration in T2D risk stratification and is likely to be useful in other chronic disease risk prediction models.
Date Issued
2021-02-09
Date Acceptance
2021-01-13
Citation
Diabetes Care, 2021, 44 (4), pp.935-943
ISSN
0149-5992
Publisher
American Diabetes Association
Start Page
935
End Page
943
Journal / Book Title
Diabetes Care
Volume
44
Issue
4
Copyright Statement
© 2021 by the American Diabetes Association https://www.diabetesjournals.org/content/licenseReaders may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.
Sponsor
Health Data Research Uk
Health Data Research Uk
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33563654
PII: dc20-2049
Grant Number
Health Data Research UK
3336025
Subjects
Endocrinology & Metabolism
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2021-02-09