SCORE2-Diabetes calculator for estimating the 10-year cardiovascular risk in type 2 diabetes

SCORE2-Diabetes is the model published in 2023 by the European Society of Cardiology for patients with type 2 diabetes mellitus [1]. It extends the SCORE2 model, used for the general population, with three diabetes-specific variables: age at diagnosis, HbA1c and the estimated glomerular filtration rate (eGFR). It was built on medical data from 229460 patients and validated in a further 217036, all free of cardiovascular disease at the start [1]. This calculator estimates the risk of myocardial infarction, stroke or cardiovascular death over the next 10 years.

The model is meant for patients with type 2 diabetes aged 40 to 69, without atherosclerotic cardiovascular disease and without severe target organ damage [2]. In these people, the risk category is set with SCORE2-Diabetes, in four steps [2]. The PREVENT calculator on this site was built in the United States, for any adult aged 30 to 79, with or without diabetes. SCORE2-Diabetes is calibrated by country, on risk regions, and applies only to type 2 diabetes. There is no SCORE2 version for type 1 diabetes, so the calculator gives no result for type 1. For type 1 diabetes use the Steno Type 1 Risk Engine calculator.

The same risk profile gives different figures from one country to another, because the frequency of cardiovascular disease differs widely between countries [3]. SCORE2 divides countries into four risk regions, by the standardized cardiovascular mortality reported by the World Health Organization [3]. The thresholds are under 100, 100 to under 150, 150 to under 300, and 300 or more deaths per 100000 inhabitants per year. The model is recalibrated separately for each region, and your country selects the region automatically [4] [5].

A 60-year-old man with an HbA1c of 8.6% (70 mmol/mol) and an eGFR of 60 has an estimated risk of 12.9% in the low-risk region [1]. In the very-high-risk region, the same man has 31.2% [1]. The list covers 56 countries in Europe, North Africa, the Middle East and Central Asia [5]. If your country is not on the list, you choose the region yourself, and the result remains an extrapolation beyond the populations the model was calibrated for. For the United States use the PREVENT calculator.

The figure is the probability of having a heart attack or a stroke, or of dying from a cardiovascular cause, over the next 10 years. A result of 15% means that, of 100 people with the same profile, about 15 will have such an event and 85 will not. It is an estimate for a group, not a prediction for you. The risk does not include the probability of developing heart failure or peripheral artery disease. With them, the figure estimated by the calculator would probably be about 15% higher [1].

There are four categories. Low risk is under 5%, moderate from 5% to under 10%, high from 10% to under 20%, and very high from 20% upwards [2]. The LDL cholesterol targets are under 100 mg/dL (2.6 mmol/L) at moderate risk and under 70 mg/dL (1.8 mmol/L) at high risk [2]. At very high risk the target is under 55 mg/dL (1.4 mmol/L), and at low risk there is no proven target [2]. People with cardiovascular disease or with severe target organ damage count directly as very high risk, without any calculation [2]. The result does not decide the treatment on its own, but opens the discussion with your doctor.

In external validation, in more than 210000 patients from four European countries, the model's ability to tell apart people with and without events was moderate [1]. The C-index, which measures this ability, was between 0.66 and 0.70 [1]. The gain over plain SCORE2 comes mainly from HbA1c, age at diagnosis and kidney function, which matter more compared with cholesterol [1]. A validation from the Netherlands found figures that were, on the whole, fairly accurate [6]. The risk was underestimated in people of low socioeconomic status or of other origin, and overestimated in those of high socioeconomic status [6].

The model does not include family history, albuminuria, ethnicity or the treatments you already take, so your doctor adjusts the figure shown by the calculator for them [1]. Under 40 and over 69 the model was not built, which is why the calculator gives no result in those age ranges. If you have had a heart attack, a stroke or peripheral artery disease, the figure does not apply to you, because your risk is already very high [2]. Use the result as a starting point for the conversation in the consulting room, not as a final answer.