Objective To inform a clinical practice guideline (BMJ Rapid Recommendations) considering sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for treatment of adults with type 2 diabetes, we summarised the available evidence regarding the performance of validated risk models on cardiovascular and kidney outcomes in these patients. Methods We systematically searched bibliographic databases in January 2020 to identify observational studies evaluating risk models for all-cause and cardiovascular mortality, heart failure (HF) hospitalisations, end-stage kidney disease (ESKD), myocardial infarction (MI) and ischaemic stroke in ambulatory adults with type 2 diabetes. Using a random effects model, we pooled discrimination measures for each model and outcome, separately, and descriptively summarised calibration plots, when available. We used the Prediction Model Risk of Bias Assessment Tool to assess risk of bias of each included study and the Grading of Recommendations, Assessment, Development, and Evaluation approach to evaluate our certainty in the evidence. Results Of 22 589 publications identified, 15 observational studies reporting on seven risk models proved eligible. Among the seven models with >1 validation cohort, the Risk Equations for Complications of Type 2 Diabetes (RECODe) had the best calibration in primary studies and the highest pooled discrimination measures for the following outcomes: all-cause mortality (C-statistics 0.75, 95% CI 0.70 to 0.80; high certainty), cardiovascular mortality (0.79, 95% CI 0.75 to 0.84; low certainty), ESKD (0.73, 95% CI 0.52 to 0.94; low certainty), MI (0.72, 95% CI 0.69 to 0.74; moderate certainty) and stroke (0.71, 95% CI 0.68 to 0.74; moderate certainty). This model does not, however, predict risk of HF hospitalisations. Conclusion Of available risk models, RECODe proved to have satisfactory calibration in primary validation studies and acceptable discrimination superior to other models, though with high risk of bias in most primary studies. Trial registration number CRD42020168351. All data relevant to the study are included in the article or uploaded as supplementary information and are widely available.

中文翻译：

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2 型糖尿病患者心血管和肾脏结局的预测模型：系统评价和荟萃分析

目的 为了告知考虑钠葡萄糖协同转运蛋白 2 抑制剂和胰高血糖素样肽 1 受体激动剂治疗成人 2 型糖尿病的临床实践指南（BMJ 快速推荐），我们总结了有关经验证的风险模型在以下方面的表现的可用证据这些患者的心血管和肾脏结果。方法 我们系统地检索了 2020 年 1 月的书目数据库，以确定评估全因死亡率和心血管死亡率、心力衰竭 (HF) 住院、终末期肾病 (ESKD)、心肌梗死 (MI) 和非卧床缺血性卒中风险模型的观察性研究。患有 2 型糖尿病的成年人。使用随机效应模型，我们分别汇总了每个模型和结果的歧视措施，并描述性地总结了校准图，有空的时候。我们使用了偏倚风险评估工具的预测模型风险来评估每项纳入研究的偏倚风险，并使用推荐分级、评估、制定和评估方法来评估我们对证据的确定性。结果 在确定的 22 589 篇出版物中，15 项报告七个风险模型的观察性研究证明符合条件。在具有 >1 个验证队列的七个模型中，2 型糖尿病并发症风险方程 (RECODe) 在初级研究中具有最佳校准，并且对以下结果的汇总歧视措施最高：全因死亡率（C 统计量 0.75， 95% CI 0.70 至 0.80；高确定性）、心血管死亡率（0.79、95% CI 0.75 至 0.84；低确定性）、ESKD（0.73、95% CI 0.52 至 0.94；低确定性）、MI（0.72、95% CI 0.69）到 0.74；中等确定性）和卒中（0.71，95% CI 0.68 至 0.74；中等确定性）。然而，该模型并不能预测 HF 住院的风险。结论 在可用的风险模型中，RECODe 在主要验证研究中证明具有令人满意的校准，并且优于其他模型的可接受的歧视，尽管在大多数主要研究中存在高偏倚风险。试用注册号 CRD42020168351。与研究相关的所有数据都包含在文章中或作为补充信息上传，并且可以广泛使用。尽管在大多数初级研究中存在高偏倚风险。试用注册号 CRD42020168351。与研究相关的所有数据都包含在文章中或作为补充信息上传，并且可以广泛使用。尽管在大多数初级研究中存在高偏倚风险。试用注册号 CRD42020168351。与研究相关的所有数据都包含在文章中或作为补充信息上传，并且可以广泛使用。