Racial differences in the performance of existing risk prediction models for incident type 2 diabetes: The CARDIA study

Mary E. Lacy, Gregory A. Wellenius, Mercedes R. Carnethon, Eric B. Loucks, April P. Carson, Xi Luo, Catarina I. Kiefe, Annie Gjelsvik, Erica P. Gunderson, Charles B. Eaton, Wen Chih Wu

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objective In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for diagnosing type 2 diabetes. However, existing models for predicting diabetes risk were developed prior to the widespread adoption of A1C. Thus, it remains unknown how well existing diabetes risk prediction models predict incident diabetes defined according to the ADA 2010 guidelines. Accordingly, we examined the performance of an existing diabetes prediction model applied to a cohort of African American (AA) and white adults from the Coronary Artery Risk Development Study in Young Adults (CARDIA). Research Design and Methods We evaluated the performance of the Atherosclerosis Risk in Communities (ARIC) diabetes risk prediction model among 2,456 participants in CARDIA free of diabetes at the 2005-2006 exam and followed for 5 years. We evaluated model discrimination, calibration, and integrated discrimination improvement with incident diabetes defined by ADA 2010 guidelines before and after adding baseline A1C to the prediction model. Results In the overall cohort, re-estimating the ARIC model in the CARDIA cohort resulted in good discrimination for the prediction of 5-year diabetes risk (area under the curve [AUC] 0.841). Adding baseline A1C as a predictor improved discrimination (AUC 0.841 vs. 0.863, P = 0.03). In race-stratified analyses, model discrimination was significantly higher in whites than AA (AUC AA 0.816 vs. whites 0.902; P = 0.008). Conclusions Addition of A1C to the ARIC diabetes risk predictionmodel improved performance overall and in racial subgroups. However, for all models examined, discrimination was better in whites than AA. Additional studies are needed to further improve diabetes risk prediction among AA.

Original languageEnglish
Pages (from-to)285-291
Number of pages7
JournalDiabetes Care
Issue number2
StatePublished - Feb 2016

Bibliographical note

Funding Information:
CARDIA is supported by the National Heart, Lung, and Blood Institute (NHLBI) (contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C), the National Institute on Aging (NIA) (Intramural Research Program), and an intra-agency agreement between NIA and NHLBI (AG0005).

Publisher Copyright:
© 2016 by the American Diabetes Association.

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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