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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:

True type 2 diabetes risk?

This is an interesting and innovative paper by Hippisley-Cox et al
(1). The QDScore algorithm suggested by the author to predict the
diagnosis of type 2 diabetes mellitus has focussed on important risk
factors such as age, family history, obesity and ethnicity.

Central obesity is a stronger risk factor for type 2 diabetes than
overall obesity. In Harvard study, waist circumference (WC) is a better
predictor of type 2 diabetes and cardiovascular complications than body
mass index (BMI). This was shown in a 13 year follow up study published in
2005 (2). Although WC is not routinely recorded in the clinical computer
system in the UK, it would be interesting to see if there is a change in
the 10 year risk when WC measurements are used instead of BMI.

Women with previous gestational diabetes are more likely to develop
type 2 diabetes. Feig et al discussed that the risk of developing type 2
diabetes after gestational diabetes increases over time (4.9 % at 15
months postpartum, 13.1 % at 5 years postpartum, 18.9 % at 9 years
postpartum) (3). Surely, the significant increase in risk means previous
gestational diabetes should be included in the risk stratification


1. Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P.
Predicting risk of type 2 diabetes in England and Wales: prospective
derivation and validation of QDScore. BMJ 2009;338:b880, doi:

2. Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of
abdominal adiposity and overall obesity in predicting risk of type 2
diabetes among men. Am. J. Clinical Nutrition, Mar 2005; 81: 555 - 563.

3. Feig, DS, Zinman, B, Wang, X, Hux, JE. Risk of development of
diabetes mellitus after diagnosis of gestational diabetes.CMAJ 2008;

Competing interests:
None declared

Competing interests: No competing interests

23 March 2009
Anantharaman Ramasamy
4th year medical student
The University of Edinburgh, EH8 9YL, UK