BACKGROUND The ubiquity of electronic health records (EHR) offers an opportunity to observe trajectories of laboratory results and vital signs over long periods of time. This study assessed the value of risk factor trajectories available in the electronic health record to predict incident type 2 diabetes. STUDY DESIGN AND METHODS Analysis was based on a large 13-year retrospective cohort of 71,545 adult, non-diabetic patients with baseline in 2005 and median follow-up time of 8 years. The trajectories of fasting plasma glucose, lipids, BMI and blood pressure were computed over three time frames (2000-2001, 2002-2003, 2004) before baseline. A novel method, Cumulative Exposure (CE), was developed and evaluated using Cox proportional hazards regression to assess risk of incident type 2 diabetes. We used the Framingham Diabetes Risk Scoring (FDRS) Model as control. RESULTS The new model outperformed the FDRS Model (.802 vs .660; p-values <2e-16). Cumulative exposure measured over different periods showed that even short episodes of hyperglycemia increase the risk of developing diabetes. Returning to normoglycemia moderates the risk, but does not fully eliminate it. The longer an individual maintains glycemic control after a hyperglycemic episode, the lower the subsequent risk of diabetes. CONCLUSION Incorporating risk factor trajectories substantially increases the ability of clinical decision support risk models to predict onset of type 2 diabetes and provides information about how risk changes over time.

中文翻译：

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使用纵向危险因素轨迹预测糖尿病临床结果。

背景技术电子健康记录（EHR）的普及提供了长期观察实验室结果和生命体征轨迹的机会。本研究评估了电子健康记录中可用的危险因素轨迹对预测 2 型糖尿病事件的价值。研究设计和方法 分析基于 71,545 名成年非糖尿病患者的 13 年大型回顾性队列，基线时间为 2005 年，中位随访时间为 8 年。计算基线前三个时间段（2000-2001、2002-2003、2004）的空腹血糖、血脂、BMI 和血压的轨迹。开发了一种新方法“累积暴露 (CE)”，并使用 Cox 比例风险回归进行评估，以评估 2 型糖尿病发生的风险。我们使用弗雷明汉糖尿病风险评分 (FDRS) 模型作为对照。结果 新模型优于 FDRS 模型（0.802 与 0.660；p 值 <2e-16）。不同时期测量的累积暴露表明，即使是短暂的高血糖也会增加患糖尿病的风险。恢复正常血糖可以减轻风险，但并不能完全消除风险。一个人在高血糖发作后维持血糖控制的时间越长，随后患糖尿病的风险就越低。结论 纳入风险因素轨迹大大提高了临床决策支持风险模型预测 2 型糖尿病发病的能力，并提供了有关风险如何随时间变化的信息。