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Gui Y, Gui S, Wang X, Li Y, Xu Y, Zhang J. Exploring the relationship between heavy metals and diabetic retinopathy: a machine learning modeling approach. Sci Rep 2024; 14:13049. [PMID: 38844504 PMCID: PMC11156935 DOI: 10.1038/s41598-024-63916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
Diabetic retinopathy (DR) is one of the leading causes of adult blindness in the United States. Although studies applying traditional statistical methods have revealed that heavy metals may be essential environmental risk factors for diabetic retinopathy, there is a lack of analyses based on machine learning (ML) methods to adequately explain the complex relationship between heavy metals and DR and the interactions between variables. Based on characteristic variables of participants with and without DR and heavy metal exposure data obtained from the NHANES database (2003-2010), a ML model was developed for effective prediction of DR. The best predictive model for DR was selected from 11 models by receiver operating characteristic curve (ROC) analysis. Further permutation feature importance (PFI) analysis, partial dependence plots (PDP) analysis, and SHapley Additive exPlanations (SHAP) analysis were used to assess the model capability and key influencing factors. A total of 1042 eligible individuals were randomly assigned to two groups for training and testing set of the prediction model. ROC analysis showed that the k-nearest neighbour (KNN) model had the highest prediction performance, achieving close to 100% accuracy in the testing set. Urinary Sb level was identified as the critical heavy metal affecting the predicted risk of DR, with a contribution weight of 1.730632 ± 1.791722, which was much higher than that of other heavy metals and baseline variables. The results of the PDP analysis and the SHAP analysis also indicated that antimony (Sb) had a more significant effect on DR. The interaction between age and Sb was more significant compared to other variables and metal pairs. We found that Sb could serve as a potential predictor of DR and that Sb may influence the development of DR by mediating cellular and systemic senescence. The study revealed that monitoring urinary Sb levels can be useful for early non-invasive screening and intervention in DR development, and also highlighted the important role of constructed ML models in explaining the effects of heavy metal exposure on DR.
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Affiliation(s)
- Yanchao Gui
- Department of Ophthalmology, Anqing Second People's Hospital, 79 Guanyuemiao Street, Anqing, 246004, China
| | - Siyu Gui
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Xinchen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Yiran Li
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yueyang Xu
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jinsong Zhang
- Department of Ophthalmology, Anqing Second People's Hospital, 79 Guanyuemiao Street, Anqing, 246004, China.
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Liang X, Li X, Li G, Wang B, Liu Y, Sun D, Liu L, Zhang R, Ji S, Yan W, Yu R, Gao Z, Liu X. A machine learning approach to predicting vascular calcification risk of type 2 diabetes: A retrospective study. Clin Cardiol 2024; 47:e24264. [PMID: 38563389 PMCID: PMC10985945 DOI: 10.1002/clc.24264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Recently, patients with type 2 diabetes mellitus (T2DM) have experienced a higher incidence and severer degree of vascular calcification (VC), which leads to an increase in the incidence and mortality of vascular complications in patients with T2DM. HYPOTHESIS To construct and validate prediction models for the risk of VC in patients with T2DM. METHODS Twenty-three baseline demographic and clinical characteristics were extracted from the electronic medical record system. Ten clinical features were screened with least absolute shrinkage and selection operator method and were used to develop prediction models based on eight machine learning (ML) algorithms (k-nearest neighbor [k-NN], light gradient boosting machine, logistic regression [LR], multilayer perception [(MLP], Naive Bayes [NB], random forest [RF], support vector machine [SVM], XGBoost [XGB]). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, and precision. RESULTS A total of 1407 and 352 patients were retrospectively collected in the training and test sets, respectively. Among the eight models, the AUC value in the NB model was higher than the other models (NB: 0.753, LGB: 0.719, LR: 0.749, MLP: 0.715, RF: 0.722, SVM: 0.689, XGB:0.707, p < .05 for all). The k-NN model achieved the highest sensitivity of 0.75 (95% confidence interval [CI]: 0.633-0.857), the MLP model achieved the highest accuracy of 0.81 (95% CI: 0.767-0.852) and specificity of 0.875 (95% CI: 0.836-0.912). CONCLUSIONS This study developed a predictive model of VC based on ML and clinical features in type 2 diabetic patients. The NB model is a tool with potential to facilitate clinicians in identifying VC in high-risk patients.
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Affiliation(s)
- Xue Liang
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
- Graduate SchoolDalian Medical UniversityDalianChina
| | - Xinyu Li
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Guosheng Li
- Laboratory Pathology DepartmentNingbo Clinical Pathology Diagnosis CenterNingboChina
| | - Bing Wang
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Yudan Liu
- Department of Neuroendocrine Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
| | - Dongli Sun
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Li Liu
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Ran Zhang
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Shukun Ji
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Wanying Yan
- International Center, InferVisionBeijingChina
| | - Ruize Yu
- International Center, InferVisionBeijingChina
| | - Zhengnan Gao
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
| | - Xuhan Liu
- Department of EndocrinologyDalian Municipal Central HospitalDalianChina
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Li Y, Huang Y, Yang S, Shychuk EM, Shenkman EA, Bian J, Angell AM, Guo Y. Machine Learning Prediction of Autism Spectrum Disorder Through Linking Mothers' and Children's Electronic Health Record Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.24.24304813. [PMID: 38585795 PMCID: PMC10996718 DOI: 10.1101/2024.03.24.24304813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder typically diagnosed in children. Early detection of ASD, particularly in girls who are often diagnosed late, can aid long-term development for children. We aimed to develop machine learning models for predicting ASD diagnosis in children, both boys and girls, using child-mother linked electronic health records (EHRs) data from a large clinical research network. Model features were children and mothers' risk factors in EHRs, including maternal health factors. We tested XGBoost and logistic regression with Random Oversampling (ROS) and Random Undersampling (RUS) to address imbalanced data. Logistic regression with RUS considering a three-year observation window for children's risk factors achieved the best performance for predicting ASD among the overall study population (AUROC = 0.798), boys (AUROC = 0.786), and girls (AUROC = 0.791). We calculated SHAP values to quantify the impacts of important clinical and sociodemographic risk factors.
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Kanbour S, Harris C, Lalani B, Wolf RM, Fitipaldi H, Gomez MF, Mathioudakis N. Machine Learning Models for Prediction of Diabetic Microvascular Complications. J Diabetes Sci Technol 2024; 18:273-286. [PMID: 38189280 PMCID: PMC10973856 DOI: 10.1177/19322968231223726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
IMPORTANCE AND AIMS Diabetic microvascular complications significantly impact morbidity and mortality. This review focuses on machine learning/artificial intelligence (ML/AI) in predicting diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). METHODS A comprehensive PubMed search from 1990 to 2023 identified studies on ML/AI models for diabetic microvascular complications. The review analyzed study design, cohorts, predictors, ML techniques, prediction horizon, and performance metrics. RESULTS Among the 74 identified studies, 256 featured internally validated ML models and 124 had externally validated models, with about half being retrospective. Since 2010, there has been a rise in the use of ML for predicting microvascular complications, mainly driven by DKD research across 27 countries. A more modest increase in ML research on DR and DN was observed, with publications from fewer countries. For all microvascular complications, predictive models achieved a mean (standard deviation) c-statistic of 0.79 (0.09) on internal validation and 0.72 (0.12) on external validation. Diabetic kidney disease models had the highest discrimination, with c-statistics of 0.81 (0.09) on internal validation and 0.74 (0.13) on external validation, respectively. Few studies externally validated prediction of DN. The prediction horizon, outcome definitions, number and type of predictors, and ML technique significantly influenced model performance. CONCLUSIONS AND RELEVANCE There is growing global interest in using ML for predicting diabetic microvascular complications. Research on DKD is the most advanced in terms of publication volume and overall prediction performance. Both DR and DN require more research. External validation and adherence to recommended guidelines are crucial.
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Affiliation(s)
| | - Catharine Harris
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Benjamin Lalani
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
| | - Risa M. Wolf
- Division of Pediatric Endocrinology,
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund
University Diabetes Centre, Lund University, Malmö, Sweden
| | - Maria F. Gomez
- Department of Clinical Sciences, Lund
University Diabetes Centre, Lund University, Malmö, Sweden
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes,
& Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
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Ramoutar RR. An Economic Analysis for the Use of Artificial Intelligence in Screening for Diabetic Retinopathy in Trinidad and Tobago. Cureus 2024; 16:e55745. [PMID: 38586698 PMCID: PMC10999161 DOI: 10.7759/cureus.55745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
This is a systematic review of 25 publications on the topics of the prevalence and cost of diabetic retinopathy (DR) in Trinidad and Tobago, the cost of traditional methods of screening for DR, and the use and cost of artificial intelligence (AI) in screening for DR. Analysis of these publications was used to identify and make estimates for how resources allocated to ophthalmology in public health systems in Trinidad and Tobago can be more efficiently utilized by employing AI in diagnosing treatable DR. DR screening was found to be an effective method of detecting the disease. Screening was found to be a universally cost-effective method of disease prevention and for altering the natural history of the disease in the spectrum of low-middle to high-income economies, such as Rwanda, Thailand, China, South Korea, and Singapore. AI and deep learning systems were found to be clinically superior to, or as effective as, human graders in areas where they were deployed, indicating that the systems are clinically safe. They have been shown to improve access to diabetic retinal screening, improve compliance with screening appointments, and prove to be cost-effective, especially in rural areas. Trinidad and Tobago, which is estimated to be disproportionately more affected by the burden of DR when projected out to the mid-21st century, stands to save as much as US$60 million annually from the implementation of an AI-based system to screen for DR versus conventional manual grading.
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Affiliation(s)
- Ryan R Ramoutar
- Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Huang Y, Guo J, Donahoo WT, Fan Z, Lu Y, Chen WH, Tang H, Bilello L, Saguil AA, Rosenberg E, Shenkman EA, Bian J. A Fair Individualized Polysocial Risk Score for Identifying Increased Social Risk in Type 2 Diabetes. RESEARCH SQUARE 2023:rs.3.rs-3684698. [PMID: 38106012 PMCID: PMC10723535 DOI: 10.21203/rs.3.rs-3684698/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Racial and ethnic minority groups and individuals facing social disadvantages, which often stem from their social determinants of health (SDoH), bear a disproportionate burden of type 2 diabetes (T2D) and its complications. It is crucial to implement effective social risk management strategies at the point of care. Objective To develop an electronic health records (EHR)-based machine learning (ML) analytical pipeline to address unmet social needs associated with hospitalization risk in patients with T2D. Methods We identified real-world patients with T2D from the EHR data from University of Florida (UF) Health Integrated Data Repository (IDR), incorporating both contextual SDoH (e.g., neighborhood deprivation) and individual-level SDoH (e.g., housing instability). The 2015-2020 data were used for training and validation and 2021-2022 data for independent testing. We developed a machine learning analytic pipeline, namely individualized polysocial risk score (iPsRS), to identify high social risk associated with hospitalizations in T2D patients, along with explainable AI (XAI) and fairness optimization. Results The study cohort included 10,192 real-world patients with T2D, with a mean age of 59 years and 58% female. Of the cohort, 50% were non-Hispanic White, 39% were non-Hispanic Black, 6% were Hispanic, and 5% were other races/ethnicities. Our iPsRS, including both contextual and individual-level SDoH as input factors, achieved a C statistic of 0.72 in predicting 1-year hospitalization after fairness optimization across racial and ethnic groups. The iPsRS showed excellent utility for capturing individuals at high hospitalization risk because of SDoH, that is, the actual 1-year hospitalization rate in the top 5% of iPsRS was 28.1%, ~13 times as high as the bottom decile (2.2% for 1-year hospitalization rate). Conclusion Our ML pipeline iPsRS can fairly and accurately screen for patients who have increased social risk leading to hospitalization in real word patients with T2D.
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Affiliation(s)
- Yu Huang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jingchuan Guo
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine
| | - Zhengkang Fan
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Ying Lu
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA
| | - Wei-Han Chen
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA
| | - Huilin Tang
- Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA
| | - Lori Bilello
- Department of Medicine, University of Florida College of Medicine
| | - Aaron A Saguil
- Department of Community Health and Family Medicine, University of Florida College of Medicine
| | - Eric Rosenberg
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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7
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Li K, Li K, Yao Q, Shui X, Zheng J, He Y, Lei W. The potential relationship of coronary artery disease and hyperuricemia: A cardiometabolic risk factor. Heliyon 2023; 9:e16097. [PMID: 37215840 PMCID: PMC10199191 DOI: 10.1016/j.heliyon.2023.e16097] [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: 03/08/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Coronary arterial disease (CAD) is the leading cause of mortality in the world. Hyperuricemia has recently emerged as a novel independent risk factor of CAD, in addition to the traditional risk factors such as hyperlipidemia, smoking, and obesity. Several clinical studies have shown that hyperuricemia is strongly associated with the risk, progression and poor prognosis of CAD, as well as verifying an association with traditional CAD risk factors. Uric acid or enzymes in the uric acid production pathway are associated with inflammation, oxidative stress, regulation of multiple signaling pathways and the renin-angiotensin-aldosterone system (RAAS), and these pathophysiological alterations are currently the main mechanisms of coronary atherosclerosis formation. The risk of death from CAD can be effectively reduced by the uric acid-lowering therapy, but the interventional treatment of uric acid levels in patients with CAD remains controversial due to the diversity of co-morbidities and the complexity of causative factors. In this review, we analyze the association between hyperuricemia and CAD, elucidate the possible mechanisms by which uric acid induces or exacerbates CAD, and discuss the benefits and drawbacks of uric acid-lowering therapy. This review could provide theoretical references for the prevention and management of hyperuricemia-associated CAD.
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Affiliation(s)
- Kaiyue Li
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases, Department of Precision Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Kongwei Li
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases, Department of Precision Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Cardiovascular Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qingmei Yao
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases, Department of Precision Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaorong Shui
- Laboratory of Vascular Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jing Zheng
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Yuan He
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases, Department of Precision Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Laboratory of Cardiovascular Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Wei Lei
- Guangdong Provincial Engineering Technology Research Center for Molecular Diagnosis and Innovative Drugs Translation of Cardiopulmonary Vascular Diseases, University Joint Laboratory of Guangdong Province and Macao Region on Molecular Targets and Intervention of Cardiovascular Diseases, Department of Precision Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Ji Y, Ji Y, Liu Y, Zhao Y, Zhang L. Research progress on diagnosing retinal vascular diseases based on artificial intelligence and fundus images. Front Cell Dev Biol 2023; 11:1168327. [PMID: 37056999 PMCID: PMC10086262 DOI: 10.3389/fcell.2023.1168327] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
As the only blood vessels that can directly be seen in the whole body, pathological changes in retinal vessels are related to the metabolic state of the whole body and many systems, which seriously affect the vision and quality of life of patients. Timely diagnosis and treatment are key to improving vision prognosis. In recent years, with the rapid development of artificial intelligence, the application of artificial intelligence in ophthalmology has become increasingly extensive and in-depth, especially in the field of retinal vascular diseases. Research study results based on artificial intelligence and fundus images are remarkable and provides a great possibility for early diagnosis and treatment. This paper reviews the recent research progress on artificial intelligence in retinal vascular diseases (including diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinopathy of prematurity, and age-related macular degeneration). The limitations and challenges of the research process are also discussed.
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Affiliation(s)
- Yuke Ji
- The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Ji
- Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, Shandong, China
| | - Yunfang Liu
- Department of Ophthalmology, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, China
| | - Ying Zhao
- Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, Shandong, China
- *Correspondence: Liya Zhang, ; Ying Zhao,
| | - Liya Zhang
- Department of Ophthalmology, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, China
- *Correspondence: Liya Zhang, ; Ying Zhao,
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Yang Y, Tan J, He Y, Huang H, Wang T, Gong J, Liu Y, Zhang Q, Xu X. Predictive model for diabetic retinopathy under limited medical resources: A multicenter diagnostic study. Front Endocrinol (Lausanne) 2023; 13:1099302. [PMID: 36686423 PMCID: PMC9849672 DOI: 10.3389/fendo.2022.1099302] [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: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Background Comprehensive eye examinations for diabetic retinopathy is poorly implemented in medically underserved areas. There is a critical need for a widely available and economical tool to aid patient selection for priority retinal screening. We investigated the possibility of a predictive model for retinopathy identification using simple parameters. Methods Clinical data were retrospectively collected from 4, 159 patients with diabetes admitted to five tertiary hospitals. Independent predictors were identified by univariate analysis and least absolute shrinkage and selection operator (LASSO) regression, and a nomogram was developed based on a multivariate logistic regression model. The validity and clinical practicality of this nomogram were assessed using concordance index (C-index), area under the receiver operating characteristic curve (AUROC), calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC). Results The predictive factors in the multivariate model included the duration of diabetes, history of hypertension, and cardiovascular disease. The three-variable model displayed medium prediction ability with an AUROC of 0.722 (95%CI 0.696-0.748) in the training set, 0.715 (95%CI 0.670-0.754) in the internal set, and 0.703 (95%CI 0.552-0.853) in the external dataset. DCA showed that the threshold probability of DR in diabetic patients was 17-55% according to the nomogram, and CIC also showed that the nomogram could be applied clinically if the risk threshold exceeded 30%. An operation interface on a webpage (https://cqmuxss.shinyapps.io/dr_tjj/) was built to improve the clinical utility of the nomogram. Conclusions The predictive model developed based on a minimal amount of clinical data available to diabetic patients with restricted medical resources could help primary healthcare practitioners promptly identify potential retinopathy.
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Affiliation(s)
- Yanzhi Yang
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Juntao Tan
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin He
- Department of Medical Administration, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Jun Gong
- Department of Information Center, The University Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yunyu Liu
- Medical Records Department, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Zhang
- Department of Endocrinology and Metabolism, Chengdu First People’s Hospital, Chengdu, China
| | - Xiaomei Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Gastroenterology, Chengdu Fifth People’s hospital, Chengdu, China
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Ke J, Li K, Cao B. A Nomogram for Predicting Vision-Threatening Diabetic Retinopathy Among Mild Diabetic Retinopathy Patients: A Case-Control and Prospective Study of Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:275-283. [PMID: 36760600 PMCID: PMC9888403 DOI: 10.2147/dmso.s394607] [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: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
AIM This study aims to develop a nomogram for predicting vision-threatening diabetic retinopathy (VTDR) in type 2 diabetes mellitus (T2DM) with mild non-proliferative diabetic retinopathy (NPDR) patients. MATERIALS AND METHODS In case-control analysis, 440 patients with mild NPDR or VTDR were enrolled to identify predictors and develop a nomogram. In the prospective cohort, 120 T2DM patients with mild NPDR were enrolled for external validation. Sensitivity, specificity, and area under the receiver operating characteristic (AUC) were calculated to evaluate the predictive performance of the nomogram. RESULTS In case-control analysis, 2-h C-peptide (OR = 0.85, 95% CI: 0.75 to 0.95, p = 0.006), sural nerve conduction impaired (SNCI) (mildly: OR = 2.18, 95% CI: 1.10 to 4.33, p = 0.026; moderately/severely: 3.66, 95% CI: 1.74 to 7.70, p < 0.001) and UACR (microalbuminuria: OR = 2.37, 95% CI: 1.25 to 4.48, p = 0.008; macroalbuminuria: 4.02, 95% CI: 1.61 to 10.06, p = 0.003) were identified as independent predictors. The concordance index of the prediction nomogram was 0.76 in the training set. In the test set, sensitivity, specificity, and AUC were 84.8%, 60.6%, and 0.73, respectively. In the prospective cohort, median follow-up period was 42 months, and 15 patients (12.5%) developed VTDR. Sensitivity, specificity, and AUC of prediction were 66.7%, 89.5%, and 0.75, respectively. CONCLUSION Introducing 2-h C-peptide, UACR, and SNCI, the nomogram demonstrated a good discriminatory power for predicting risk of VTDR in mild NPDR individuals.
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Affiliation(s)
- Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Bin Cao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
- Correspondence: Bin Cao, Tel +86-10-6954-3901, Email
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Zou X, Liu Y, Ji L. Review: Machine learning in precision pharmacotherapy of type 2 diabetes-A promising future or a glimpse of hope? Digit Health 2023; 9:20552076231203879. [PMID: 37786401 PMCID: PMC10541760 DOI: 10.1177/20552076231203879] [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] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
Precision pharmacotherapy of diabetes requires judicious selection of the optimal therapeutic agent for individual patients. Artificial intelligence (AI), a swiftly expanding discipline, holds substantial potential to transform current practices in diabetes diagnosis and management. This manuscript provides a comprehensive review of contemporary research investigating drug responses in patient subgroups, stratified via either supervised or unsupervised machine learning approaches. The prevalent algorithmic workflow for investigating drug responses using machine learning involves cohort selection, data processing, predictor selection, development and validation of machine learning methods, subgroup allocation, and subsequent analysis of drug response. Despite the promising feature, current research does not yet provide sufficient evidence to implement machine learning algorithms into routine clinical practice, due to a lack of simplicity, validation, or demonstrated efficacy. Nevertheless, we anticipate that the evolving evidence base will increasingly substantiate the role of machine learning in molding precision pharmacotherapy for diabetes.
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Affiliation(s)
- Xiantong Zou
- Xiantong Zou, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China.
| | | | - Linong Ji
- Linong Ji, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China.
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