ASCEND primary prevention diabetes model


Information last updated: July 2022

Participated in following Mt Hood Diabetes Challenge Meetings: 2022 Malmo. 

Publicly accessible?:  Full details of model and R code to be published.

Is the model continuing to be developed?: Yes

Brief Description:

A Study of Cardiovascular Events iN Diabetes (ASCEND) recruited 15,480 participants with diabetes without previous cardiovascular disease, and is one of the largest diabetes trials conducted to date. Participants were recruited between 2005 and 2011 and followed up till 2017 for an average of 7 years. Risk equations were estimated using the ASCEND data, and these were integrated into a patient-level stochastic simulation model which predicts the likelihood of occurrence of cardiovascular, bleeding, cancer, amputation, end-stage renal disease and death events over the lifetime of a patient given their baseline characteristics.


The simulation model was externally validated in a cohort of 18,250 participants identified to match the ASCEND eligibility criteria from the UK Biobank, a longitudinal prospective observational cohort. The simulation model performed well for key cardiovascular and cancer outcomes. Where discrepancies between model predictions and observed event rates in the UK Biobank were found, the reasons behind the discrepancies were identified and appropriate adjustments were made to the risk equations. 


Estimates of hospital costs and health-related quality of life (QoL) associated with the adverse events in the simulation model, derived from the ASCEND data, were incorporated into the simulation model to quantify lifetime cost and QoL. The newly developed and validated framework reflects event rates, costs and QoL in contemporary diabetes cohorts, and can be used to model long-term health outcomes and costs for people with diabetes without previous cardiovascular disease.

Funding source for model development: 

The development of the model was supported by a grant from the British Heart Foundation Centre of Research Excellence, Oxford (grant code: RE/13/1/30181).

Key Publications:

Keng MJ, Leal J, Bowman L, Armitage J, Mihaylova B, on behalf of the ASCEND Study Collaborative Group. Hospital Costs Associated with Adverse Events in People with Diabetes in the UK. Diabetes, Obesity and Metabolism 2022;1-10. doi: 10.1111/dom.14796

Keng MJ, Leal J, Bowman L, Armitage J, Mihaylova B, on behalf of the ASCEND Study Collaborative Group. Decrements in Health-Related Quality of Life Associated with Adverse Events in People with Diabetes. Diabetes, Obesity and Metabolism 2022;24:530–8. doi: 10.1111/dom.14610