The establishment and preliminary verification of a risk model for the prediction of diabetic retinopathy in patients with type 2 diabetes_Chinese Journal of Ocular Fundus Diseases

Authors：

Lyu Zhe , Chen Yiqi ,  Shen Lijun , Lin Li , Chen Lifeng , Li Liang , Wu Hanfei , Li Chulan , Mao Jianbo

Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou 310020, China;

Corresponding author：

Shen Lijun, Email: slj@mail.eye.ac.cn

Keywords：

Diabetic retinopathy/prevention & control; Models, statistical; Forecasting

DOI：

10.3760/cma.j.issn.1005-1015.2017.03.009

Video：

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Objective To establish a risk prediction model of diabetic retinopathy (DR) for type 2 diabetic patients (T2DM). Methods A total of 315 T2DM patients (600 eyes) were enrolled in the study. There were 132 males (264 eyes) and 183 females (366 eyes). The mean age was (67.28±12.17) years and the mean diabetes duration was (10.86±7.81) years. The subjects were randomly assigned to model group and check group, each had 252 patients (504 eyes) and 63 patients (126 eyes) respectively. Some basic information including gender, age, education degree and diabetes duration were collected. The probable risk factors of DR including height, weight, blood pressure, fasting glucose, glycosylated hemoglobin (HbA1c), blood urea, serum creatinine, uric acid, triglyceride, total cholesterol, high-density lipoprotein, low density lipoprotein cholesterol and urinary protein. The fundus photograph and the axial length were measured. Multivariate logistic regression was used to analyze the correlative factors of DR and establish the regression equation (risk model). Receiver operating characteristic (ROC) curves were used to determine the cut-off point for the score. The maximum Youden Index was used to determine the threshold of the equation. The check group was used to check the feasibility of the predictive model. Results Among 504 eyes in the model group, 170 eyes were DR and 334 eyes were not. Among 126 eyes in the check group, 45 eyes were DR and 81 eyes were not. Multivariate logistic regression analysis revealed that axial length [β=–0.196, odds ratio (OR)=0.822,P＜0.001], age (β=-0.079,OR=0.924,P＜0.001), diabetes duration (β=0.048,OR=1.049,P=0.001), HbA1c (β=0.184,OR=1.202,P=0.020), urinary protein (β=1.298,OR=3.661,P＜0.001) were correlated with DR significantly and the simplified calculation of the score of DR were as follows:P=7.018–0.196X1–0.079X2+0.048X3+0.148X4+1.298X5 (X1= axial length, X2=age, X3=diabetes duration, X4=glycosylated hemoglobin, X5= urinary protein). The area under the ROC curve for the score DR was 0.800 and the cut-off point of the score was -1.485. The elements of the check group were substituted into the equation to calculate the scores and the scores were compared with the diagnostic threshold to ensure the patients in high-risk of DR. The result of the score showed 84% sensitivity and 59% specificity. ROC curve for the score to predict DR was 0.756. Conclusion Axial length, age, diabetes duration, HbA1c and urinary protein have significant correlation with DR. The sensitivity and specificity of the risk model to predict DR are 84.0% and 59.0% respectively. The area under the ROC curve was 0.756.

Citation： Lyu Zhe, Chen Yiqi, Shen Lijun, Lin Li, Chen Lifeng, Li Liang, Wu Hanfei, Li Chulan, Mao Jianbo. The establishment and preliminary verification of a risk model for the prediction of diabetic retinopathy in patients with type 2 diabetes. Chinese Journal of Ocular Fundus Diseases, 2017, 33(3): 257-261. doi: 10.3760/cma.j.issn.1005-1015.2017.03.009 Copy

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3.	Cichosz SL, Johansen MD, Knudsen ST. A classification model for predicting eye disease in newly diagnosed people with type 2 diabetes[J]. Diabetes Res Clin Pract, 2015, 108(2): 210-215. DOI: 10.1016/j.diabres.2015.02.020.
4.	Azizi-Soleiman F, Heidari-Beni M, Ambler G, et al. Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes[J]. Can J Diabetes, 2015, 39(5): 358-363. DOI: 10.1016/j.jcjd.2015.01.290.
5.	Man REK, Sasongko MB, Sanmugasundram S, et al. Longer axial length is protective of diabetic retinopathy and macular edema[J]. Ophthalmology, 2012, 119(9): 1754-1759. DOI: 10.1016/j.ophtha.2012.03.021.
6.	Bazzazi N, Akbarzadeh S, Yavarikia M, et al. High myopia and diabetic retinopathy: a contralateral eye study in diabetic patients with high myopic anisometropia [J/OL]. Retina, 2016, E1[2016-09-30]. . DOI: 10.1097/IAE.0000000000001335. [published online ahead of print].
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11.	张建文, 马丽, 马凤仙.糖尿病视网膜病变发生发展的相关因素分析[J]. 国际眼科杂志, 2013, 13(11): 2262-2266. DOI: 10.3980/j.issn.1672-5123.2013.11.29.Zhang JW, Ma L, Ma FX. Analysis of related factors in the development of diabetic retinopathy[J]. Int Eye Sci, 2013, 13(11): 2262-2266. DOI: 10.3980/j.issn.1672-5123.2013.11.29.
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13.	孙清秀, 滕峰, 张振华, 等.糖尿病相关专业医师(非眼科)218名对糖尿病性视网膜病变的认知度研究[J]. 中华临床医师杂志, 2016, 10(13): 2030-2034. DOI: 10.3877/cma.j.issn.1674-0785.2016.13.041.Sun QX, Teng F, Zhang ZH, et al. A study on cognition of Diabetic Retinopathy of 218 diabetes-related professional physicians(non-ophthalmologist)[J]. Chin J Clinicians, 2016, 10(13): 2030-2034. DOI: 10.3877/cma.j.issn.1674-0785.2016.13.041.
14.	Wang X, Tang L, Gao L, et al. Myopia and diabetic retinopathy: a systematic review and meta-analysis[J]. Diabetes Res Clin Pract, 2015, 111: 1-9. DOI: 10.1016/j.diabres.2015.10.020.
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16.	Lim LS, Cheung CY, Lin X, et al. Influence of refractive error and axial length on retinal vessel geometric characteristics[J]. Invest Ophthalmol Vis Sci, 2011, 52(2): 669-678. DOI: 10.1167/iovs.10-6184.
17.	Sawada O, Kawamura H, Kakinoki M, et al. Vascular endothelial growth factor in the aqueous humour in eyes with myopic choroidal neovascularization.[J]. Acta Ophthalmol, 2011, 89(5): 459-462. DOI: 10.1111/j.1755-3768.2009.01717.x.
18.	Saw SM, Gazzard G, Shih-Yen EC, et al. Myopia and associated pathological complications[J]. Ophthalmic Physiol Opt, 2005, 25(5): 381-391. DOI: 10.1111/j.1475-1313.2005.00298.x.
19.	Akiba J, Arzabe CW, Trempe CL.Posterior vitreous detachment and neovascularization in diabetic retinopathy[J]. Ophthalmology, 1990, 97(7): 889-891.
20.	Mallika PS, Aziz S, Goh PP, et al. Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry[J]. Med J Malaysia, 2012, 67(4): 369-374.
21.	Miller JW, Adamis AP, Aiello LP. Vascular endothelial growth factor in ocular neovascularization and proliferative diabetic retinopathy[J]. Diabete Metab Rev, 1997, 13(1): 37-50.
22.	Raman R, Gupta A.Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation: response[J]. Diabetol Metab Syndr, 2010, 2: 20. DOI: 10.1186/1758-5996-2-20.
23.	Dowse GK, Humphrey ARG, Collins VR, et al. Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius[J]. Am J Epidemiol, 1998, 147(5): 448-457.
24.	Benarous R, Sasongko M, Qureshi S, et al. Differential association of serum lipids with diabetic retinopathy and diabetic macular edema[J]. Invest Ophthalmol Vis Sci, 2011, 27, 52(10): 7464-7469. DOI: 10.1167/iovs.11-7598.
25.	Miljanovic B, Glynn R, Nathan D, et al. A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes[J]. Diabetes, 2004, 53(11): 2883-2892.
26.	Aspelund T, Thornórisdóttir O, Olafsdottir E, et al. Individual risk assessment and information technology to optimise screening frequency for diabetic retinopathy[J]. Diabetologia, 2011, 54(10): 2525-2532. DOI: 10.1007/s00125-011-2257-7.

1. Jones S, Edwards RT. Diabetic retinopathy screening: a systematic review of the economic evidence[J]. Diabet Med, 2010, 27(3): 249-256. DOI: 10.1111/j.1464-5491.2009.02870.x.
2. Cichosz SL, Johansen MD, Ejskjaer N, et al. A novel model enhances HbA1c-based diabetes screening using simple anthropometric, anamnestic, and demographic information[J]. J Diabetes, 2014, 6(5): 478-484. DOI: 10.1111/1753-0407.12130.
3. Cichosz SL, Johansen MD, Knudsen ST. A classification model for predicting eye disease in newly diagnosed people with type 2 diabetes[J]. Diabetes Res Clin Pract, 2015, 108(2): 210-215. DOI: 10.1016/j.diabres.2015.02.020.
4. Azizi-Soleiman F, Heidari-Beni M, Ambler G, et al. Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes[J]. Can J Diabetes, 2015, 39(5): 358-363. DOI: 10.1016/j.jcjd.2015.01.290.
5. Man REK, Sasongko MB, Sanmugasundram S, et al. Longer axial length is protective of diabetic retinopathy and macular edema[J]. Ophthalmology, 2012, 119(9): 1754-1759. DOI: 10.1016/j.ophtha.2012.03.021.
6. Bazzazi N, Akbarzadeh S, Yavarikia M, et al. High myopia and diabetic retinopathy: a contralateral eye study in diabetic patients with high myopic anisometropia [J/OL]. Retina, 2016, E1[2016-09-30]. . DOI: 10.1097/IAE.0000000000001335. [published online ahead of print].
7. 杨凯博, 胡悦东, 刘磊, 等.眼轴长度与糖尿病性视网膜病变及其黄斑水肿相关研究[J]. 中国实用眼科杂志, 2015, 33(5): 517-522. DOI: 10.3760/cma.j.issn.1006-4443.2015.05.018.Yang KB, Hu YD, Liu L, et al. The relationship between axial length and diabetic retinopathy and macular edema[J]. Chin J Pract Ophthalmol, DOI: 10.3760/cma.j.issn.1006-4443.2015.05.018.
8. 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J]. 中华糖尿病杂志, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.Chinese Diabetes Society, Chinese Medical Association. Standards of care for type 2 diabetes in China[J]. Chin J Diabetes Mellitus, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.
9. 中华医学会眼科学分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
10. Kahtani ESA, Khandekar R, Alrubeaan K, et al. Assessment of the prevalence and risk factors of ophthalmoplegia among diabetic patients in a large national diabetes registry cohort[J]. BMC Ophthalmol, 2016, 16(1): 118. DOI: 10.1186/s12886-016-0272-7.
11. 张建文, 马丽, 马凤仙.糖尿病视网膜病变发生发展的相关因素分析[J]. 国际眼科杂志, 2013, 13(11): 2262-2266. DOI: 10.3980/j.issn.1672-5123.2013.11.29.Zhang JW, Ma L, Ma FX. Analysis of related factors in the development of diabetic retinopathy[J]. Int Eye Sci, 2013, 13(11): 2262-2266. DOI: 10.3980/j.issn.1672-5123.2013.11.29.
12. 赵耐清. 临床医学研究设计和数据分析[M]. 上海: 复旦大学出版社, 2005: 241-252.Zhao NQ. Clinical medicine research design and data analysis[M]. Shanghai: Fudan University Press, 2005: 241-252.
13. 孙清秀, 滕峰, 张振华, 等.糖尿病相关专业医师(非眼科)218名对糖尿病性视网膜病变的认知度研究[J]. 中华临床医师杂志, 2016, 10(13): 2030-2034. DOI: 10.3877/cma.j.issn.1674-0785.2016.13.041.Sun QX, Teng F, Zhang ZH, et al. A study on cognition of Diabetic Retinopathy of 218 diabetes-related professional physicians(non-ophthalmologist)[J]. Chin J Clinicians, 2016, 10(13): 2030-2034. DOI: 10.3877/cma.j.issn.1674-0785.2016.13.041.
14. Wang X, Tang L, Gao L, et al. Myopia and diabetic retinopathy: a systematic review and meta-analysis[J]. Diabetes Res Clin Pract, 2015, 111: 1-9. DOI: 10.1016/j.diabres.2015.10.020.
15. Fu Y, Geng D, Liu H, et al. Myopia and/or longer axial length are protective against diabetic retinopathy: a meta-analysis[J]. Acta Ophthalmol, 2015, 94(4): 346-352. DOI: 10.1111/aos.12908.
16. Lim LS, Cheung CY, Lin X, et al. Influence of refractive error and axial length on retinal vessel geometric characteristics[J]. Invest Ophthalmol Vis Sci, 2011, 52(2): 669-678. DOI: 10.1167/iovs.10-6184.
17. Sawada O, Kawamura H, Kakinoki M, et al. Vascular endothelial growth factor in the aqueous humour in eyes with myopic choroidal neovascularization.[J]. Acta Ophthalmol, 2011, 89(5): 459-462. DOI: 10.1111/j.1755-3768.2009.01717.x.
18. Saw SM, Gazzard G, Shih-Yen EC, et al. Myopia and associated pathological complications[J]. Ophthalmic Physiol Opt, 2005, 25(5): 381-391. DOI: 10.1111/j.1475-1313.2005.00298.x.
19. Akiba J, Arzabe CW, Trempe CL.Posterior vitreous detachment and neovascularization in diabetic retinopathy[J]. Ophthalmology, 1990, 97(7): 889-891.
20. Mallika PS, Aziz S, Goh PP, et al. Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry[J]. Med J Malaysia, 2012, 67(4): 369-374.
21. Miller JW, Adamis AP, Aiello LP. Vascular endothelial growth factor in ocular neovascularization and proliferative diabetic retinopathy[J]. Diabete Metab Rev, 1997, 13(1): 37-50.
22. Raman R, Gupta A.Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation: response[J]. Diabetol Metab Syndr, 2010, 2: 20. DOI: 10.1186/1758-5996-2-20.
23. Dowse GK, Humphrey ARG, Collins VR, et al. Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius[J]. Am J Epidemiol, 1998, 147(5): 448-457.
24. Benarous R, Sasongko M, Qureshi S, et al. Differential association of serum lipids with diabetic retinopathy and diabetic macular edema[J]. Invest Ophthalmol Vis Sci, 2011, 27, 52(10): 7464-7469. DOI: 10.1167/iovs.11-7598.
25. Miljanovic B, Glynn R, Nathan D, et al. A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes[J]. Diabetes, 2004, 53(11): 2883-2892.
26. Aspelund T, Thornórisdóttir O, Olafsdottir E, et al. Individual risk assessment and information technology to optimise screening frequency for diabetic retinopathy[J]. Diabetologia, 2011, 54(10): 2525-2532. DOI: 10.1007/s00125-011-2257-7.

Chinese Journal of Ocular Fundus Diseases

The establishment and preliminary verification of a risk model for the prediction of diabetic retinopathy in patients with type 2 diabetes

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