Derivation and Validation of a Risk Index to Predict All-Cause Mortality in Type 2 Diabetes Mellitus

Christine Xia Wu, Woan Shin Tan, Matthias Paul Han Sim Toh, Bee Hoon Heng


Background: Type 2 Diabetes Mellitus with severe complications have higher risk of mortality. An easy-to-use risk index to quantify the risk of mortality would help clinicians identify patients who might benefit from more intensive therapy. The study aims to develop a risk index to predict all-cause mortality for a cohort of T2DM patients seen at primary care clinics in Singapore.

Methods: In a retrospective cohort study, 28 patient-level variables were extracted from an automated clinical and administrative registry for T2DM who had at least 2 visits to the same National Healthcare Group Polyclinic in 2007. Demographic characteristics, inpatient and outpatient diagnoses, laboratory results and prescription were included. Mortality data were provided by the Ministry of Health. We used a split-sample design to derive and validate an index to predict the risk of death within 2 years of the index attendance. The c-statistic was used to assess model discrimination.

Results: Out of the 59,747 patients in the study, 2,977 (5%) patients died during the 2-year follow up. Age (A); diabetes-related complications (Diabetes Complication Severity Index) (C); and cancer history (C) were found to independently predict all-cause mortality (from which the mnemonic ACC was derived). The ACC risk index ranged from 0 to 20 with expected risk of mortality of 0.3% to 80.6%. The discriminatory accuracy of the ACC risk index for the validation data is excellent (c-statistic 0.83, 95% CI 0.82 - 0.84).

Conclusion: A simple risk index for all-cause mortality was successfully developed, and validated using routinely collected registry data. The risk index can be used to stratify T2 DM patients into varying risk of mortality. Further external validation of the risk index is needed before using it in a clinical setting.

J Endocrinol Metab. 2012;2(2):88-95


Type 2 Diabetes Mellitus; Diabetes-related complications; Mortality; Risk index

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.