Intended for healthcare professionals

Rapid response to:


Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore

BMJ 2009; 338 doi: (Published 18 March 2009) Cite this as: BMJ 2009;338:b880

Rapid Response:

The devil is in the detail

Dear Sir,

The report by Hippisley-Cox et al is timely, given the twin epidemics
of diabetes and obesity sweeping the world and causing much suffering.
While I await further validation of the model with great interest, it is
already a potentially useful tool for risk stratification and patient

I have one major concern about the online calculator
( as it currently stands. While most of the questions
clearly describe risk factors for the development of diabetes, the wording
of the question asking 'Are you on blood pressure treatment' strongly
suggests that it is the treatment rather than the blood pressure that
increases the risk of diabetes. This misinformation is potentially
compounded if a user of the calculator tries the calculation with and
without this check-box ticked, where the risk of diabetes appears lower if
the person is not receiving blood pressure lowering agents. I believe
there is a substantial risk that the calculator as it stands could
therefore cause some individuals to cease their required blood pressure
treatment in the mistaken belief that this might reduce the risk of
diabetes, when it will instead potentially increase the risk of
cardiovascular and other complications related to their blood pressure

I am sure this is not the intention of the authors, and expect that a
minor change to the wording will clarify the issue (an alternative
phrasing could be: Do you have high blood pressure requiring treatment?),
and urge the authors to make this change as soon as possible.

Yours sincerely,

Dr Vlado Perkovic

Competing interests:
None declared

Competing interests: No competing interests

20 March 2009
Vlado Perkovic
Renal Division, George Institute, Missenden Rd, Sydney 2050 Australia