Model of Complications of NIDDM: I. Model construction and assumptions
- Richard C Eastman, MD,
- Jonathan C Javitt, MD,
- William H Herman, MD,
- Erik J Dasbach, PHD,
- Arthur S Zbrozek, MBA,
- Fred Dong,
- Diane Manninen, PHD,
- Sanford A Garfield, PHD,
- Catherine Copley-Merriman, MBA,
- William Maier, PHD,
- Jeffery F Eastman, PHD,
- James Kotsanos, MD,
- Catherine C Cowie, PHD and
- Maureen Harris, PHD
- Division of Diabetes, Endocrinology, and Metabolic Diseases Indianapolis, Indiana
- National Institute of Diabetes and Digestive and Kidney Diseases Bethesda, Maryland Department of Ophthalmology Indianapolis, Indiana
- Worthen Center for Eye Care Research, Georgetown University, School of Medicine Washington, D.C. Division of Endocrinology and Metabolism Indianapolis, Indiana
- Department of Internal Medicine, University of Michigan, Epidemiology and Outcomes Research Indianapolis, Indiana
- Parke-Davis Inc., Ann Arbor, Michigan; Merck Inc. Indianapolis, Indiana
- Bluebell, Pennsylvania Bayer Inc. Indianapolis, Indiana
- West Haven, Connecticut Battelle Inc. Indianapolis, Indiana
- Seattle, Washington Windward Solutions Indianapolis, Indiana
- Redwood City, California Eli Lilly Inc.Indianapolis, Indiana
- Address correspondence and reprint requests to Richard C. Eastman, MD, Director, Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDK, Building 31, Room 9A16, 31 Center Dr. MSC 2560, National Institutes of Health, Bethesda, MD 20892−2560.
OBJECTIVE To develop a model of NIDDM for analyzing prevention strategies for NIDDM.
RESEARCH DESIGN AND METHODS A Markov type model with Monte Carlo techniques was used. Age, sex, and ethnicity of cohort was based on U.S. data. Incidence rates of complications were also based on community and population studies.
RESULTS Nonproliferative retinopathy, proliferative retinopathy, and macular edema are predicted in 79, 19, and 52%, respectively, of people with NIDDM; 19% are predicted to develop legal blindness. Microalbuminuria, gross proteinuria, and end-stage renal disease related to diabetes are predicted in 53, 40, and 17%, respectively. Symptomatic sensorimotor neuropathy and lower-extremity amputation are predicted in 31 and 17%, respectively. Cardiovascular disease is predicted in 39%. Higher rates of complications (1.1−3.0×) are predicted in minority populations. Predicted average life expectancy is 17 years after diagnosis.
CONCLUSIONS A probabilistic model of NIDDM predicts the vascular complications of NIDDM in a cohort representative of the incident cases of diabetes in the U.S. before age 75 years. Predictions of complications and mortality are consistent with the known epidemiology of NIDDM. The model is suitable for evaluating the effect of preventive interventions on the natural history of NIDDM.
- Received July 29, 1996.
- Accepted October 27, 1996.
- Copyright © 1997 by the American Diabetes Association