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Mulat Tebeje T, Kindie Yenit M, Gedlu Nigatu S, Bizuneh Mengistu S, Kidie Tesfie T, Byadgie Gelaw N, Moges Chekol Y. Prediction of diabetic retinopathy among type 2 diabetic patients in University of Gondar Comprehensive Specialized Hospital, 2006-2021: A prognostic model. Int J Med Inform 2024; 190:105536. [PMID: 38970878 DOI: 10.1016/j.ijmedinf.2024.105536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND There has been a paucity of evidence for the development of a prediction model for diabetic retinopathy (DR) in Ethiopia. Predicting the risk of developing DR based on the patient's demographic, clinical, and behavioral data is helpful in resource-limited areas where regular screening for DR is not available and to guide practitioners estimate the future risk of their patients. METHODS A retrospective follow-up study was conducted at the University of Gondar (UoG) Comprehensive Specialized Hospital from January 2006 to May 2021 among 856 patients with type 2 diabetes (T2DM). Variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. The data were validated by 10-fold cross-validation. Four ML techniques (naïve Bayes, K-nearest neighbor, decision tree, and logistic regression) were employed. The performance of each algorithm was measured, and logistic regression was a well-performing algorithm. After multivariable logistic regression and model reduction, a nomogram was developed to predict the individual risk of DR. RESULTS Logistic regression was the best algorithm for predicting DR with an area under the curve of 92%, sensitivity of 87%, specificity of 83%, precision of 84%, F1-score of 85%, and accuracy of 85%. The logistic regression model selected seven predictors: total cholesterol, duration of diabetes, glycemic control, adherence to anti-diabetic medications, other microvascular complications of diabetes, sex, and hypertension. A nomogram was developed and deployed as a web-based application. A decision curve analysis showed that the model was useful in clinical practice and was better than treating all or none of the patients. CONCLUSIONS The model has excellent performance and a better net benefit to be utilized in clinical practice to show the future probability of having DR. Identifying those with a higher risk of DR helps in the early identification and intervention of DR.
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Affiliation(s)
- Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia.
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Segenet Bizuneh Mengistu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
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Matboli M, Al-Amodi HS, Khaled A, Khaled R, Roushdy MMS, Ali M, Diab GI, Elnagar MF, Elmansy RA, TAhmed HH, Ahmed EME, Elzoghby DMA, M.Kamel HF, Farag MF, ELsawi HA, Farid LM, Abouelkhair MB, Habib EK, Fikry H, Saleh LA, Aboughaleb IH. Comprehensive machine learning models for predicting therapeutic targets in type 2 diabetes utilizing molecular and biochemical features in rats. Front Endocrinol (Lausanne) 2024; 15:1384984. [PMID: 38854687 PMCID: PMC11157016 DOI: 10.3389/fendo.2024.1384984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/03/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction With the increasing prevalence of type 2 diabetes mellitus (T2DM), there is an urgent need to discover effective therapeutic targets for this complex condition. Coding and non-coding RNAs, with traditional biochemical parameters, have shown promise as viable targets for therapy. Machine learning (ML) techniques have emerged as powerful tools for predicting drug responses. Method In this study, we developed an ML-based model to identify the most influential features for drug response in the treatment of type 2 diabetes using three medicinal plant-based drugs (Rosavin, Caffeic acid, and Isorhamnetin), and a probiotics drug (Z-biotic), at different doses. A hundred rats were randomly assigned to ten groups, including a normal group, a streptozotocin-induced diabetic group, and eight treated groups. Serum samples were collected for biochemical analysis, while liver tissues (L) and adipose tissues (A) underwent histopathological examination and molecular biomarker extraction using quantitative PCR. Utilizing five machine learning algorithms, we integrated 32 molecular features and 12 biochemical features to select the most predictive targets for each model and the combined model. Results and discussion Our results indicated that high doses of the selected drugs effectively mitigated liver inflammation, reduced insulin resistance, and improved lipid profiles and renal function biomarkers. The machine learning model identified 13 molecular features, 10 biochemical features, and 20 combined features with an accuracy of 80% and AUC (0.894, 0.93, and 0.896), respectively. This study presents an ML model that accurately identifies effective therapeutic targets implicated in the molecular pathways associated with T2DM pathogenesis.
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Affiliation(s)
- Marwa Matboli
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hiba S. Al-Amodi
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdelrahman Khaled
- Bioinformatics Group, Center of Informatics Sciences (CIS), School of Information Technology and Computer Sciences, Nile University, Giza, Egypt
| | - Radwa Khaled
- Biotechnology/Biomolecular Chemistry Department, Faculty of Science, Cairo University, Cairo, Egypt
- Medicinal Biochemistry and Molecular Biology Department, Modern University for Technology and Information, Cairo, Egypt
| | - Marian M. S. Roushdy
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Ali
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Rasha A. Elmansy
- Anatomy Unit, Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Buraydah, Saudi Arabia
- Department of Anatomy and Cell Biology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hagir H. TAhmed
- Anatomy Unit, Department of Basic Medical Sciences, College of Medicine and Medical Sciences, AlNeelain University, Khartoum, Sudan
| | - Enshrah M. E. Ahmed
- Pathology Unit, Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Gassim University, Buraydah, Saudi Arabia
| | | | - Hala F. M.Kamel
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Biochemistry Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamed F. Farag
- Medical Physiology Department, Armed Forces College of Medicine, Cairo, Egypt
| | - Hind A. ELsawi
- Department of Internal Medicine, Badr University in Cairo, Badr, Egypt
| | - Laila M. Farid
- Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Eman K. Habib
- Department of Anatomy and Cell Biology, Faculty of Medicine, Galala University, Attaka, Suez Governorate, Egypt
| | - Heba Fikry
- Department of Histology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Lobna A. Saleh
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Du K, Luo W. Association between blood urea nitrogen levels and diabetic retinopathy in diabetic adults in the United States (NHANES 2005-2018). Front Endocrinol (Lausanne) 2024; 15:1403456. [PMID: 38800479 PMCID: PMC11116622 DOI: 10.3389/fendo.2024.1403456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To investigate the association between blood urea nitrogen (BUN) levels and diabetic retinopathy (DR) in adults with diabetes mellitus (DM). Methods Seven cycles of cross-sectional population information acquired from NHANES(national health and nutrition examination surveys) 2005-2018 were collected, from which a sample of diabetic adults was screened and separated into two groups based on whether or not they had DR, followed by weighted multivariate regression analysis. This study collected a complete set of demographic, biological, and sociological risk factor indicators for DR. Demographic risk factors comprised age, gender, and ethnicity, while biological risk factors included blood count, blood pressure, BMI, waist circumference, and glycated hemoglobin. Sociological risk factors included education level, deprivation index, smoking status, and alcohol consumption. Results The multiple regression model revealed a significant connection between BUN levels and DR [odds ratio =1.04, 95% confidence interval (1.03-1.05), p-value <0.0001],accounting for numerous variables. After equating BUN levels into four groups, multiple regression modeling showed the highest quartile (BUN>20 mg/dl) was 2.22 times more likely to develop DR than the lowest quartile [odds ratio =2.22, 95% confidence interval (1.69-2.93), p- value <0.0001]. Subgroup analyses revealed that gender, race, diabetes subtype, and duration of diabetes had a regulating effect on the relationship between BUN and DR. Conclusion BUN levels were related with an increased prevalence of DR, particularly in individuals with BUN >20 mg/dl. These findings highlight the significance of BUN level in assessing the risk of DR.
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Affiliation(s)
| | - Wenjuan Luo
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Cai SS, Zheng TY, Wang KY, Zhu HP. Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus. World J Diabetes 2024; 15:43-52. [PMID: 38313855 PMCID: PMC10835501 DOI: 10.4239/wjd.v15.i1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/25/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Among older adults, type 2 diabetes mellitus (T2DM) is widely recognized as one of the most prevalent diseases. Diabetic nephropathy (DN) is a frequent complication of DM, mainly characterized by renal microvascular damage. Early detection, aggressive prevention, and cure of DN are key to improving prognosis. Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis. AIM To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model. METHODS The clinical data of 210 patients diagnosed with T2DM and admitted to the First People's Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed. According to whether the patients had DN, they were divided into the DN group (complicated with DN) and the non-DN group (without DN). Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM. The data were randomly split into a training set (n = 147) and a test set (n = 63) in a 7:3 ratio using a random function. The training set was used to construct the nomogram, decision tree, and random forest models, and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity, specificity, accuracy, recall, precision, and area under the receiver operating characteristic curve. RESULTS Among the 210 patients with T2DM, 74 (35.34%) had DN. The validation dataset showed that the accuracies of the nomogram, decision tree, and random forest models in predicting DN in patients with T2DM were 0.746, 0.714, and 0.730, respectively. The sensitivities were 0.710, 0.710, and 0.806, respectively; the specificities were 0.844, 0.875, and 0.844, respectively; the area under the receiver operating characteristic curve (AUC) of the patients were 0.811, 0.735, and 0.850, respectively. The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models (P < 0.05), whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant (P > 0.05). CONCLUSION Among the three prediction models, random forest performs best and can help identify patients with T2DM at high risk of DN.
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Affiliation(s)
- Sha-Sha Cai
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Teng-Ye Zheng
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Kang-Yao Wang
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
| | - Hui-Ping Zhu
- Department of Nephrology, The First People’s Hospital of Wenling, Wenling 317500, Zhejiang Province, China
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Tse G, Lee Q, Chou OHI, Chung CT, Lee S, Chan JSK, Li G, Kaur N, Roever L, Liu H, Liu T, Zhou J. Healthcare Big Data in Hong Kong: Development and Implementation of Artificial Intelligence-Enhanced Predictive Models for Risk Stratification. Curr Probl Cardiol 2024; 49:102168. [PMID: 37871712 DOI: 10.1016/j.cpcardiol.2023.102168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
Routinely collected electronic health records (EHRs) data contain a vast amount of valuable information for conducting epidemiological studies. With the right tools, we can gain insights into disease processes and development, identify the best treatment and develop accurate models for predicting outcomes. Our recent systematic review has found that the number of big data studies from Hong Kong has rapidly increased since 2015, with an increasingly common application of artificial intelligence (AI). The advantages of big data are that i) the models developed are highly generalisable to the population, ii) multiple outcomes can be determined simultaneously, iii) ease of cross-validation by for model training, development and calibration, iv) huge numbers of useful variables can be analyzed, v) static and dynamic variables can be analyzed, vi) non-linear and latent interactions between variables can be captured, vii) artificial intelligence approaches can enhance the performance of prediction models. In this paper, we will provide several examples (cardiovascular disease, diabetes mellitus, Brugada syndrome, long QT syndrome) to illustrate efforts from a multi-disciplinary team to identify data from different modalities to develop models using territory-wide datasets, with the possibility of real-time risk updates by using new data captured from patients. The benefit is that only routinely collected data are required for developing highly accurate and high-performance models. AI-driven models outperform traditional models in terms of sensitivity, specificity, accuracy, area under the receiver operating characteristic and precision-recall curve, and F1 score. Web and/or mobile versions of the risk models allow clinicians to risk stratify patients quickly in clinical settings, thereby enabling clinical decision-making. Efforts are required to identify the best ways of implementing AI algorithms on the web and mobile apps.
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Affiliation(s)
- Gary Tse
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Quinncy Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Oscar Hou In Chou
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Division of Clinical Pharmacology and Therapeutics, Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk To Chung
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Sharen Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Jeffrey Shi Kai Chan
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Narinder Kaur
- Family Medicine Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; School of Cardiovascular Science & Metabolic Health, University of Glasgow, UK
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, MG 38400384, Brazil
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jiandong Zhou
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Zhong JB, Yao YF, Zeng GQ, Zhang Y, Ye BK, Dou XY, Cai L. A closer association between blood urea nitrogen and the probability of diabetic retinopathy in patients with shorter type 2 diabetes duration. Sci Rep 2023; 13:9881. [PMID: 37336896 DOI: 10.1038/s41598-023-35653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
Blood urea nitrogen (BUN) is an indicator of renal function and catabolic status in human body. Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a serious threat to the vision of diabetic patients. We included 426 type 2 diabetic patients who visited the endocrinology department of Guangdong Provincial People's Hospital and received an ophthalmology consultation from December 2017 to November 2018. The outcome was the probability of DR in participants. Multivariable logistics analysis was used to confirm the relationship between BUN and the probability of DR. And interaction tests were conducted to find the effects of DM duration on their association. A total of 167 of 426 patients with type 2 diabetes had DR, with a probability of 39.20%. After adjusting for potential confounders, a positive association between BUN and the probability of DR (OR = 1.12; 95% CI 1.03-1.21; P = 0.0107). And a test for interaction between DM duration and BUN on the probability of DR was significant (P = 0.0295). We suggested that in patients with type 2 diabetes, BUN was positively associated with the probability of DR and the association was influenced by DM duration.
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Affiliation(s)
- Jian-Bo Zhong
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
- Shenzhen University Medical College, No. 3688 Nanhai Ave, Shenzhen, 518061, Guangdong Province, China
| | - Yu-Feng Yao
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, Shantou, 515031, Guangdong Province, China
| | - Guo-Qiang Zeng
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
- Shenzhen University Medical College, No. 3688 Nanhai Ave, Shenzhen, 518061, Guangdong Province, China
| | - Yi Zhang
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China
| | - Bai-Kang Ye
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, Shantou, 515031, Guangdong Province, China
| | - Xiao-Yan Dou
- Department of Ophthalmology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China.
| | - Li Cai
- Department of Ophthalmology, Shenzhen University General Hospital, Shenzhen, Guangdong Province, China.
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Pan H, Sun J, Luo X, Ai H, Zeng J, Shi R, Zhang A. A risk prediction model for type 2 diabetes mellitus complicated with retinopathy based on machine learning and its application in health management. Front Med (Lausanne) 2023; 10:1136653. [PMID: 37181375 PMCID: PMC10172657 DOI: 10.3389/fmed.2023.1136653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This study aimed to establish a risk prediction model for diabetic retinopathy (DR) in the Chinese type 2 diabetes mellitus (T2DM) population using few inspection indicators and to propose suggestions for chronic disease management. Methods This multi-centered retrospective cross-sectional study was conducted among 2,385 patients with T2DM. The predictors of the training set were, respectively, screened by extreme gradient boosting (XGBoost), a random forest recursive feature elimination (RF-RFE) algorithm, a backpropagation neural network (BPNN), and a least absolute shrinkage selection operator (LASSO) model. Model I, a prediction model, was established through multivariable logistic regression analysis based on the predictors repeated ≥3 times in the four screening methods. Logistic regression Model II built on the predictive factors in the previously released DR risk study was introduced into our current study to evaluate the model's effectiveness. Nine evaluation indicators were used to compare the performance of the two prediction models, including the area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, F1 score, balanced accuracy, calibration curve, Hosmer-Lemeshow test, and Net Reclassification Index (NRI). Results When including predictors, such as glycosylated hemoglobin A1c, disease course, postprandial blood glucose, age, systolic blood pressure, and albumin/urine creatinine ratio, multivariable logistic regression Model I demonstrated a better prediction ability than Model II. Model I revealed the highest AUROC (0.703), accuracy (0.796), precision (0.571), recall (0.035), F1 score (0.066), Hosmer-Lemeshow test (0.887), NRI (0.004), and balanced accuracy (0.514). Conclusion We have built an accurate DR risk prediction model with fewer indicators for patients with T2DM. It can be used to predict the individualized risk of DR in China effectively. In addition, the model can provide powerful auxiliary technical support for the clinical and health management of patients with diabetes comorbidities.
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Affiliation(s)
- Hong Pan
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jijia Sun
- Department of Mathematics and Physics, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Luo
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Heling Ai
- Department of Public Utilities Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Zeng
- Department of Public Utilities Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Shi
- Department of Public Utilities Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Rong Shi,
| | - An Zhang
- Department of Health Management, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- An Zhang,
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Yang J, Jiang S. Development and validation of a model that predicts the risk of diabetic retinopathy in type 2 diabetes mellitus patients. Acta Diabetol 2023; 60:43-51. [PMID: 36163520 DOI: 10.1007/s00592-022-01973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/12/2022] [Indexed: 01/07/2023]
Abstract
AIMS Diabetic retinopathy is the leading cause of blindness in people with type 2 diabetes. To enable primary care physicians to identify high-risk type 2 diabetic patients with diabetic retinopathy at an early stage, we developed a nomogram model to predict the risk of developing diabetic retinopathy in the Xinjiang type 2 diabetic population. METHODS In a retrospective study, we collected data on 834 patients with type 2 diabetes through an electronic medical record system. Stepwise regression was used to filter variables. Logistic regression was applied to build a nomogram prediction model and further validated in the training set. The c-index, forest plot, calibration plot, and clinical decision curve analysis were used to comprehensively validate the model and evaluate its accuracy and clinical validity. RESULTS Four predictors were selected to establish the final model: hypertension, blood urea nitrogen, duration of diabetes, and diabetic peripheral neuropathy. The model displayed medium predictive power with a C-index of 0.781(95%CI:0.741-0.822) in the training set and 0.865(95%CI:0.807-0.923)in the validation set. The calibration curve of the DR probability shows that the predicted results of the nomogram are in good agreement with the actual results. Decision curve analysis demonstrated that the novel nomogram was clinically valuable. CONCLUSIONS The nomogram of the risk of developing diabetic nephropathy contains 4 characteristics. that can help primary care physicians quickly identify individuals at high risk of developing DR in patients with type 2 diabetes, to intervene as soon as possible.
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Affiliation(s)
- Jing Yang
- State Key Laboratory of Pathogenesis, Prevention andTreatment of High Incidence Diseases in Central Asia, Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, China
| | - Sheng Jiang
- State Key Laboratory of Pathogenesis, Prevention andTreatment of High Incidence Diseases in Central Asia, Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, China.
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Hung TW, Yu MH, Yang TY, Yang MY, Chen JY, Chan KC, Wang CJ. Acarbose Protects Glucolipotoxicity-Induced Diabetic Nephropathy by Inhibiting Ras Expression in High-Fat Diet-Fed db/db Mice. Int J Mol Sci 2022; 23:ijms232315312. [PMID: 36499639 PMCID: PMC9736061 DOI: 10.3390/ijms232315312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
Diabetic nephropathy (DN) exacerbates renal tissue damage and is a major cause of end-stage renal disease. Reactive oxygen species play a vital role in hyperglycemia-induced renal injury. This study examined whether the oral hypoglycemic drug acarbose (Ab) could attenuate the progression of DN in type 2 diabetes mellitus mice. In this study, 50 mg/kg body weight of Ab was administered to high-fat diet (HFD)-fed db/db mice. Their body weight was recorded every week, and the serum glucose concentration was monitored every 2 weeks. Following their euthanasia, the kidneys of mice were analyzed through hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and immunohistochemistry (IHC) staining. The results revealed that Ab stabilized the plasma glucose and indirectly improved the insulin sensitivity and renal functional biomarkers in diabetic mice. In addition, diabetes-induced glomerular hypertrophy, the saccharide accumulation, and formation of collagen fiber were reduced in diabetic mice receiving Ab. Although the dosages of Ab cannot decrease the blood sugar in db/db mice, our results indicate that Ab alleviates glucolipotoxicity-induced DN by inhibiting kidney fibrosis-related proteins through the Ras/ERK pathway.
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Affiliation(s)
- Tung-Wei Hung
- School of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medicine, Division of Nephrology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Meng-Hsun Yu
- Department of Nutrition, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Road, Taichung 402, Taiwan
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402, Taiwan
| | - Tsung-Yuan Yang
- School of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Mon-Yuan Yang
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402, Taiwan
| | - Jia-Yu Chen
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402, Taiwan
| | - Kuei-Chuan Chan
- School of Medicine, Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (K.-C.C.); (C.-J.W.); Tel.: +886-4-247-30022 (ext. 34704) (K.-C.C.); +886-4-247-30022 (ext. 11670) (C.-J.W.)
| | - Chau-Jong Wang
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (K.-C.C.); (C.-J.W.); Tel.: +886-4-247-30022 (ext. 34704) (K.-C.C.); +886-4-247-30022 (ext. 11670) (C.-J.W.)
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Gosak L, Martinović K, Lorber M, Stiglic G. Artificial intelligence based prediction models for individuals at risk of multiple diabetic complications: A systematic review of the literature. J Nurs Manag 2022; 30:3765-3776. [PMID: 36329678 PMCID: PMC10100477 DOI: 10.1111/jonm.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/03/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIM The aim of this review is to examine the effectiveness of artificial intelligence in predicting multimorbid diabetes-related complications. BACKGROUND In diabetic patients, several complications are often present, which have a significant impact on the quality of life; therefore, it is crucial to predict the level of risk for diabetes and its complications. EVALUATION International databases PubMed, CINAHL, MEDLINE and Scopus were searched using the terms artificial intelligence, diabetes mellitus and prediction of complications to identify studies on the effectiveness of artificial intelligence for predicting multimorbid diabetes-related complications. The results were organized by outcomes to allow more efficient comparison. KEY ISSUES Based on the inclusion/exclusion criteria, 11 articles were included in the final analysis. The most frequently predicted complications were diabetic neuropathy (n = 7). Authors included from two to a maximum of 14 complications. The most commonly used prediction models were penalized regression, random forest and Naïve Bayes model neural network. CONCLUSION The use of artificial intelligence can predict the risks of diabetes complications with greater precision based on available multidimensional datasets and provides an important tool for nurses working in preventive health care. IMPLICATIONS FOR NURSING MANAGEMENT Using artificial intelligence contributes to a better quality of care, better autonomy of patients in diabetes management and reduction of complications, costs of medical care and mortality.
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Affiliation(s)
- Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Kristina Martinović
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia.,Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Gregor Stiglic
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia.,Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia.,Usher Institute, University of Edinburgh, Edinburgh, UK
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Zhang X, Wang Y, Yang Z, Chen X, Zhang J, Wang X, Jin X, Wu L, Xing X, Yang W, Zhang B. Development and assessment of diabetic nephropathy prediction model using hub genes identified by weighted correlation network analysis. Aging (Albany NY) 2022; 14:8095-8109. [PMID: 36242604 PMCID: PMC9596198 DOI: 10.18632/aging.204340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022]
Abstract
Diabetic nephropathy (DN) is one microvascular complication of diabetes. About 30% of diabetic patients can develop DN, which is closely related to the high incidence and mortality of heart diseases, and then develop end-stage renal diseases. Therefore, early detection and screening of high-risk patients with DN is important. Herein, we explored the differences of serum transcriptomics between DN and non-DN in type II diabetes mellitus (T2DM) patients. We obtained 110 target genes using weighted correlation network analysis. Gene Ontology enrichment analysis indicates these target genes are mainly related to membrane adhesion, alpha-amino acid biosynthesis, metabolism, and binding, terminus, inhibitory synapse, clathrinid-sculpted vesicle, kinase activity, hormone binding, receptor activity, and transporter activity. Kyoto Encyclopedia of Genes and Genomes analysis indicates the process of DN in diabetic patients can involve synaptic vesicle cycle, cysteine and methionine metabolism, N-Glycan biosynthesis, osteoclast differentiation, and cAMP signaling pathway. Next, we detected the expression levels of hub genes in a retrospective cohort. Then, we developed a risk score tool included in the prediction model for early DN in T2DM patients. The prediction model was well applied into clinical practice, as confirmed by internal validation and several other methods. A novel DN risk model with relatively high prediction accuracy was established based on clinical characteristics and hub genes of serum detection. The estimated risk score can help clinicians develop individualized intervention programs for DN in T2DM. External validation data are required before individualized intervention measures.
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Affiliation(s)
- Xuelian Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yao Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Zhaojun Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xiaoping Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Jinping Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xin Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xian Jin
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Lili Wu
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xiaoyan Xing
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
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Li Z, Deng X, Zhou L, Lu T, Lan Y, Jin C. Nomogram-based prediction of clinically significant macular edema in diabetes mellitus patients. Acta Diabetol 2022; 59:1179-1188. [PMID: 35739321 DOI: 10.1007/s00592-022-01901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/27/2022] [Indexed: 11/01/2022]
Abstract
AIMS The aim of the study was to construct and validate a risk nomogram for clinically significant macular edema (CSME) prediction in diabetes mellitus (DM) patients using systemic variables. METHODS In this retrospective study, DM inpatients who underwent routine diabetic retinopathy screening were recruited and divided into training and validation sets according to their admission date. Ninety-three demographic and systemic variables were collected. The least absolute shrinkage and selection operator was used to select the predictive variables from the training set. The selected variables were used to construct the CSME prediction nomogram. Internal and external validations were performed. The C-index, calibration curve and decision curve analysis (DCA) were reported. RESULTS A total of 349 patients were divided into the training set (240, 68.77%) and the validation set (109, 31.23%). The presence of diabetic peripheral neuropathy (DPN) symptoms, uric acid, use of insulin only or not for treatment, insulin dosage, urinary protein grade and disease duration were chosen for the nomogram. The C-index of the prediction nomogram was 0.896, 0.878 and 0.837 in the training set, internal validation and external validation, respectively. The calibration curves of the nomogram showed good agreement between the predicted and actual outcomes. DCA demonstrated that the nomogram was clinically useful. CONCLUSIONS A nomogram with good performance for predicting CSME using systemic variables was developed. It suggested that DPN symptoms and renal function may be crucial risk factors for CSME. Moreover, this nomogram may be a convenient tool for non-ophthalmic specialists to rapidly recognize CSME in patients and to transfer them to ophthalmologists for early diagnosis and treatment.
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Affiliation(s)
- Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China
| | - Xiaowen Deng
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510020, China.
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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Yang J, Jiang S. Development and Validation of a Model That Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Int J Gen Med 2022; 15:5089-5101. [PMID: 35645579 PMCID: PMC9130557 DOI: 10.2147/ijgm.s363474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose To develop a nomogram model that predicts the risk of diabetic nephropathy (DN) incidence in type 2 diabetes mellitus (T2DM) patients. Methods We collect information from electronic medical record systems. The data were split into a training set (n=521) containing 73.8% of patients and a validation set (n=185) holding the remaining 26.2% of patients based on the date of data collection. Stepwise and multivariable logistic regression analyses were used to screen out DN risk factors. A predictive model including selected risk factors was developed by logistic regression analysis. The results of binary logistic regression are presented through forest plots and nomogram. Lastly, the c-index, calibration plots, and receiver operating characteristic (ROC) curves were used to assess the accuracy of the nomogram in internal and external validation. The clinical benefit of the model was evaluated by decision curve analysis. Results Predictors included serum creatinine (Scr), hypertension, glycosylated hemoglobin A1c (HbA1c), blood urea nitrogen (BUN), body mass index (BMI), triglycerides (TG), and Diabetic peripheral neuropathy (DPN). Harrell’s C-indexes were 0.773 (95% CI:0.726–0.821) and 0.758 (95% CI:0.679–0.837) in the training and validation sets, respectively. Decision curve analysis (DCA) demonstrated that the novel nomogram was clinically valuable. Conclusion Our simple nomogram with seven factors may help clinicians predict the risk of DN incidence in patients with T2DM.
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Affiliation(s)
- Jing Yang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia; Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, People’s Republic of China
| | - Sheng Jiang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia; Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, People’s Republic of China
- Correspondence: Sheng Jiang, Email
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Li C, Su F, Liang Z, Zhang L, Liu F, Fan W, Li Z. Macrophage M1 regulatory diabetic nephropathy is mediated by m6A methylation modification of lncRNA expression. Mol Immunol 2022; 144:16-25. [DOI: 10.1016/j.molimm.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/07/2021] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
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Liu L, Wang M, Li G, Wang Q. Construction of Predictive Model for Type 2 Diabetic Retinopathy Based on Extreme Learning Machine. Diabetes Metab Syndr Obes 2022; 15:2607-2617. [PMID: 36046759 PMCID: PMC9420743 DOI: 10.2147/dmso.s374767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The common cause of blindness in people with type 2 diabetes (T2D) is diabetic retinopathy (DR). Early fundus examinations have been shown to prevent vision loss, but routine ophthalmic screenings for patients with diabetes present significant financial and material challenges to existing health-care systems. The purpose of this study is to build a DR prediction model based on the extreme learning machine (ELM) and to compare the performance with the DR prediction models based on support machine vector (SVM), K proximity (KNN), random forest (RF) and artificial neural network (ANN). METHODS From January 1, 2020 to November 31, 2021, data were collected from electronic inpatient medical records at Lu'an Hospital of Anhui Medical University in China. An extreme learning machine (ELM) algorithm was used to develop a prediction model based on demographic data and blood testing and urine test results. Several metrics were used to evaluate the model's performance: (1) classification accuracy (ACC), (2) sensitivity, (3) specificity, (4) Precision,(5) Negative predictive value (NPV), (6) Training time and (7) area under the receiver operating characteristic (ROC) curve (AUC). RESULTS In terms of ACC, Sensitivity, Specificity, Precision, NPV and AUC, DR prediction model based on SVM and ELM is better than DR prediction model based on ANN, KNN and RF. The prediction model for diabetic retinopathy based on elm is the best among them in terms of ACC, Precision, Specificity, Training time and AUC, with 84.45%, 83.93%, 93.16%,1.24s, and 88.34%, respectively. The DR prediction model based on SVM is the best in terms of sensitivity and NPV, which are, respectively, 70.82% and 85.60%. CONCLUSION According to the findings of this study, the model based on the extreme learning machine presents an outstanding performance in predicting diabetic retinopathy thus providing technological assistance for screening of diabetic retinopathy.
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Affiliation(s)
- Lei Liu
- Graduate School of Bengbu Medical College, Bengbu Medical College, Bengbu City, People’s Republic of China
| | - Mengmeng Wang
- Graduate School of Bengbu Medical College, Bengbu Medical College, Bengbu City, People’s Republic of China
| | - Guocheng Li
- School of Finance & Mathematics, West Anhui University, Lu’an City, People’s Republic of China
| | - Qi Wang
- Graduate School of Bengbu Medical College, Bengbu Medical College, Bengbu City, People’s Republic of China
- Department of Endocrinology, Lu’an Hospital of Anhui Medical University, Lu’an City, People’s Republic of China
- Correspondence: Qi Wang, Department of Endocrinology, Lu’an Hospital of Anhui Medical University, No. 21, Wanxi West Road, Lu’an City, People’s Republic of China, Tel +86-13966299858, Email
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Wang Q, Zeng N, Tang H, Yang X, Yao Q, Zhang L, Zhang H, Zhang Y, Nie X, Liao X, Jiang F. Diabetic retinopathy risk prediction in patients with type 2 diabetes mellitus using a nomogram model. Front Endocrinol (Lausanne) 2022; 13:993423. [PMID: 36465620 PMCID: PMC9710381 DOI: 10.3389/fendo.2022.993423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aims to develop a diabetic retinopathy (DR) hazard nomogram for a Chinese population of patients with type 2 diabetes mellitus (T2DM). METHODS We constructed a nomogram model by including data from 213 patients with T2DM between January 2019 and May 2021 in the Affiliated Hospital of Zunyi Medical University. We used basic statistics and biochemical indicator tests to assess the risk of DR in patients with T2DM. The patient data were used to evaluate the DR risk using R software and a least absolute shrinkage and selection operator (LASSO) predictive model. Using multivariable Cox regression, we examined the risk factors of DR to reduce the LASSO penalty. The validation model, decision curve analysis, and C-index were tested on the calibration plot. The bootstrapping methodology was used to internally validate the accuracy of the nomogram. RESULTS The LASSO algorithm identified the following eight predictive variables from the 16 independent variables: disease duration, body mass index (BMI), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), homeostatic model assessment-insulin resistance (HOMA-IR), triglyceride (TG), total cholesterol (TC), and vitamin D (VitD)-T3. The C-index was 0.848 (95% CI: 0.798-0.898), indicating the accuracy of the model. In the interval validation, high scores (0.816) are possible from an analysis of a DR nomogram's decision curve to predict DR. CONCLUSION We developed a non-parametric technique to predict the risk of DR based on disease duration, BMI, FPG, HbA1c, HOMA-IR, TG, TC, and VitD.
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Affiliation(s)
- Qian Wang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ni Zeng
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongbo Tang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Xiaoxia Yang
- Department of Integrated (Geriatric) Ward, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qu Yao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lin Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Han Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ying Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaomei Nie
- Department of Ophthalmology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Liao
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Xin Liao, ; Feng Jiang,
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- *Correspondence: Xin Liao, ; Feng Jiang,
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Zhang J, Deng Y, Wan Y, He S, Cai W, Xu J. Association Between Serum Albumin Level and Microvascular Complications of Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:2173-2182. [PMID: 35911499 PMCID: PMC9329574 DOI: 10.2147/dmso.s373160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To analyze the associations between serum albumin (sALB) level and diabetic microvascular complications, including diabetic retinopathy (DR) and diabetic kidney disease (DKD), in patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective study included 951 hospitalized patients with T2DM who had completed screening for DR and DKD during hospitalization. Patients were divided into three groups according to sALB tertiles. Multivariate logistic regression analysis was used to assess the association of sALB with microvascular complications. RESULTS The prevalence of DR, DKD and macroalbuminuria increased with decreasing sALB levels. Multivariate logistic regression analysis showed that lower levels of sALB (Q1) were associated with higher risk of DR (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.12-2.26), DKD (OR: 3.00, 95% CI: 2.04-4.41) and macroalbuminuria (OR: 9.76, 95% CI: 4.62-20.63) compared with higher levels of sALB (Q3) after adjustment for other risk factors. After stratification by sex and age, the effect of lower levels of sALB (Q1) on DR incidence was more obvious in patients with male (OR: 1.60, 95% CI: 1.00-2.56), and aged<65 years (OR: 1.74, 95% CI: 1.14-2.65) (P < 0.05 for all); the effect of lower levels of sALB (Q1) on the incidence of DKD was significant in both males (OR: 3.78, 95% CI: 2.26-6.32) and females (OR: 2.35, 95% CI: 1.26-4.35) (P < 0.05 for all), while only the age <65 years (OR: 3.46, 95% CI: 2.16-5.53) was significant in the age subgroup (P < 0.001). CONCLUSION Decreased sALB levels may be an independent risk indicator of DR and DKD in patients with T2DM, and significantly associated with DKD progression. For DR screening, special attention should be paid to men aged <65 years, while screening for DKD should pay attention to people <65 years old.
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Affiliation(s)
- Jie Zhang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Yuanyuan Deng
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Yang Wan
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Shasha He
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Wei Cai
- Department of Medical Genetics and Cell Biology, Medical College of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, Jiangxi, 330006, People’s Republic of China
- Correspondence: Jixiong Xu, Email
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Shigidi MM, Karrar WN. Risk factors associated with the development of diabetic kidney disease in Sudanese patients with type 2 diabetes mellitus: A case-control study. Diabetes Metab Syndr 2021; 15:102320. [PMID: 34700293 DOI: 10.1016/j.dsx.2021.102320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Limited data are available regarding the risk factors associated with the development of diabetic kidney disease (DKD) among Sudanese adults with type 2 diabetes mellitus (T2DM). METHODS A case-control study was conducted at Dr. Salma Center for Kidney Diseases between April and September 2019. Patients with T2DM and DKD were compared to age and sex-matched T2DM patients with no kidney disease (NKD). Socio-demographic features, clinical findings, and laboratory investigations of the study subjects and controls were analyzed using SPSS. RESULTS A total of 372 patients with DKD were compared to 364 T2DM patients with NKD. The mean age of the DKD patients was 58 ± 13.4 years, their median eGFR was 37.3 ± 4.9 ml/min/1.73 m2; they had their T2DM at a significantly younger age compared to controls (P = 0.014). Logistic regression analysis revealed that a family history of diabetes mellitus, a family history of chronic kidney disease, the presence of hypertension, obesity, hypercholesterolemia, hyperuricemia, smoking, recurrent urinary tract infection, and the regular use of non-steroidal anti-inflammatory drugs were significantly associated with the development of DKD (P values < 0.05). CONCLUSION A series of modifiable risk factors were found to be significant determinants for developing DKD. Primary care physicians are expected to pay considerable attention to their control.
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Affiliation(s)
- Mazin Mt Shigidi
- Department of Internal Medicine, College of Medicine, Jouf University, Saudi Arabia.
| | - Wieam N Karrar
- Dr. Salma Center for Kidney Diseases, University of Khartoum, Khartoum, Sudan
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Yao X, Pei X, Yang Y, Zhang H, Xia M, Huang R, Wang Y, Li Z. Distribution of diabetic retinopathy in diabetes mellitus patients and its association rules with other eye diseases. Sci Rep 2021; 11:16993. [PMID: 34417507 PMCID: PMC8379227 DOI: 10.1038/s41598-021-96438-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
The study aims to explore the distribution characteristics and influencing factors of diabetic retinopathy (DR) in diabetes mellitus (DM) patients and association rules of eye diseases in these patients. Data were obtained from 1284 DM patients at Henan Provincial People’s Hospital. Association rules were employed to calculate the probability of the common occurrence of eye-related diseases in DM patients. A web visualization network diagram was used to display the association rules of the eye-related diseases in DM patients. DR prevalence in people aged < 40 years (≥ 58.5%) was higher than that in those aged 50–60 years (≤ 43.7%). Patients with DM in rural areas were more likely to have DR than those in urban areas (56.2% vs. 35.6%, P < 0.001). DR prevalence in Pingdingshan City (68.4%) was significantly higher than in other cities. The prevalence of DR in patients who had DM for ≥ 5 years was higher than in other groups (P < 0.001). About 33.07% of DM patients had both diabetic maculopathy and DR, and 36.02% had both diabetic maculopathy and cataracts. The number of strong rules in patients ≥ 60 years old was more than those in people under 60 in age, and those in rural areas had more strong rules than those in urban areas. DM patients with one or more eye diseases are at higher risks of other eye diseases than general DM patients. These association rules are affected by factors such as age, region, disease duration, and DR severity.
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Affiliation(s)
- Xi Yao
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China
| | - Xiaoting Pei
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China.
| | - Yingrui Yang
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China
| | - Hongmei Zhang
- Nursing Department, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Mengting Xia
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China
| | - Ranran Huang
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China
| | - Yuming Wang
- Departments of Science and Technology Administration, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhijie Li
- Henan Eye Institute, Henan Eye Hospital, and Henan Key Laboratory of Ophthalmology and Visual Science, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou City, 450000, China.
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Xi C, Wang C, Rong G, Deng J. A Nomogram Model that Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Retrospective Study. Int J Endocrinol 2021; 2021:6672444. [PMID: 33897777 PMCID: PMC8052141 DOI: 10.1155/2021/6672444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To construct a novel nomogram model that predicts the risk of diabetic nephropathy (DN) incidence in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS Questionnaire surveys, physical examinations, routine blood tests, and biochemical index evaluations were conducted on 1095 patients with T2DM from Guilin. A least absolute contraction selection operator (LASSO) regression and multivariable logistic regression analysis were used to screen out DN risk factors. A logistic regression analysis incorporating the screened risk factors was used to establish a predictive nomogram model. The performance of the nomogram model was evaluated using the C-index, an area under the receiver operating characteristic curve (AUC), calibration plots, and a decision curve analysis. Bootstrapping was applied for internal validation. RESULTS Independent predictors for DN incidence risk included gender, age, hypertension, medicine use, duration of diabetes, body mass index, blood urea nitrogen level, serum creatinine level, neutrophil to lymphocyte ratio, and red blood cell distribution width. The nomogram model exhibited moderate prediction ability with a C-index of 0.819 (95% confidence interval (CI): 0.783-0.853) and an AUC of 0.813 (95%CI: 0.778-0.848). The C-index from internal validation reached 0.796 (95%CI: 0.763-0.829). The decision curve analysis displayed that the DN risk nomogram was clinically applicable when the risk threshold was between 1 and 83%. CONCLUSION Our novel and simple nomogram containing 10 factors may be useful in predicting DN incidence risk in T2DM patients.
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Affiliation(s)
- Chunfeng Xi
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Caimei Wang
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Guihong Rong
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jinhuan Deng
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
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Foveal avascular zone analysis by optical coherence tomography angiography in patients with type 1 and 2 diabetes and without clinical signs of diabetic retinopathy. Int Ophthalmol 2020; 41:649-658. [PMID: 33156947 DOI: 10.1007/s10792-020-01621-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the early macular microvascular alterations in patients with type 1 and 2 diabetes mellitus (DM) without diabetic retinopathy (DR), using optical coherence tomography angiography (OCT-A), and compare these with nondiabetic patients. METHODS This prospective study involved 93 patients with type 1 diabetes (DM1), 104 patients with type 2 diabetes (DM2) without signs of DR, and 71 healthy subjects for the control group. The foveal avascular zone (FAZ) area and the vessel density (VD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS The SCP and DCP FAZ areas were significantly larger in the DM1 group in comparison with the controls (p = .001), while no significant differences were observed between the DM2 group and the healthy control group (p = .12). Additionally, no significant differences in FAZ area were found between the DM1 and DM2 groups (p = .26). The VD was significantly reduced in DM1 and DM2 groups compared to controls. A direct correlation was found between the duration of diabetes and SCP FAZ area (r = 0.44; R2 = 0.19; p = .0001). Statistically significant differences in the FAZ area at SCP and DCP were observed when comparing patients with a diabetes duration > 10 years and < 10 years in the DM2 group (p = .0001, respectively) and only in the FAZ area at the DCP in the DM1 group (p = .0001). CONCLUSION Diabetic patients without DR demonstrate early microvascular alteration in the macular area on OCT-A, which is more pronounced in type I DM, and correlates with the duration of the disease.
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