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：

Duan Chunwen ,  An Meixia , Liu Yanli , Liu Yi , Xu Hanchun , Wang Yanfang , Zheng Yarong

Department of Ophtalmology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510631, China;

Corresponding author：

An Meixia, Email: anmeixia@163.com

Keywords：

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

DOI：

10.3760/cma.j.issn.1005-1015.2019.02.009

Video：

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Objective To establish an appropriate diabetic retinopathy (DR) risk assessment model for patients with type 2 diabetes mellitus (T2DM).Methods A retrospective clinical analysis. From January 2016 to December 2017, 753 T2DM patients in the Third Affiliated Hospital of Southern Medical University were analyzed retrospectively. Digital fundus photography was taken in all patients. Fasting plasma glucose (FPG), HbA1c, total bilirubin (TB), blood platelet, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), apolipoprotein-A (apoA), apolipoprotein-B (apoB), serum creatinine, blood urea nitrogen (BUN), blood uric acid, fibrinogen (Fg), estimated glomerular filtration (eGFR) were collected. The patients were randomly assigned to model group and testify group, each had 702 patients and 51 patients respectively. Logistic regression was used to screen risk factors of DR and develop an assessment scale that can be used to predict DR. Goodness of fit was examined using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve.Results Among 702 patients in the model group, 483 patients were DR, 219 patients were NDR. The scores for DR risk were duration of diabetes ≥4.5 years, 4 points; total bilirubin ＜6.65 mol/L, 2 points; apoA≥1.18 g/L, 2 points; blood urea≥6.46 mmol/L, 1 points; HbA1c ≥7.75%, 2 points; HDL-c＜1.38 mmol/L, 2 points; diabetic nephropathy, 3 points; fibrinogen, 1 point. The area under the receiver operating characteristic curve was 0.787. The logistic regression analysis showed that the risk factors independently associated with DR were duration of diabetes (β=1.272, OR=3.569, 95%CI 2.283−5.578, P＜0.001), TB (β=0.744, OR=2.104, 95%CI 1.404−3.152, P＜0.001, BUN (β=0.401, OR=1.494, 95%CI 0.996−2.240, P=0.052), HbA1c (β=0.545, OR=1.724, 95%CI 1.165−2.55, P=0.006), HDL-c (β=0.666, OR=1.986, 95%CI 1.149−3.298, P=0.013), diabetic nephropathy (β=1.151, OR=3.162, 95%CI 2.080−4.806, P=0.013), Fg (β=0.333, OR=1.396, 95%CI 0.945−2.061, P=0.094). The risk model was P=1/[1+exp−^{(−3.799+1.272X1+0.744X2+0.769X3+0.401X4+0.545X5+0.666X6+1.151X7+0.333X8)}]. X₁= duration of diabetes, X₂=TB, X₃=apoA, X₄=BUN, X₅=HbA1c, X₆=HDL-c, X₇=diabetic nephropathy, X₈=Fg. The area under the ROC curve was 0.787 and the Hosmer-Lemeshow test suggested excellent agreement (χ²=10.125, df=8, P=0.256) in model group. The area under the ROC curve was 0.869 and the Hosmer-Lemeshow test suggested excellent agreement (χ²=5.345, df=7, P=0.618) in model group.Conclusion The area under the ROC curve for DR was 0.787. The duration of diabetes, TB, BUN, HbA1c, HDL-c, diabetic nephropathy, apoA, Fg are the risk factors of DR in T2DM patients.

Citation： Duan Chunwen, An Meixia, Liu Yanli, Liu Yi, Xu Hanchun, Wang Yanfang, Zheng Yarong. 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, 2019, 35(2): 150-155. doi: 10.3760/cma.j.issn.1005-1015.2019.02.009 Copy

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11.	刘玉成.临床常用生物化学检测[M]//陈文彬, 潘祥林, 康熙雄, 等.诊断学.7版.北京: 人民卫生出版社, 2012: 382-383.Liu YC.Common clinical biochemical tests[M]//Chen WB, Pan XL, Kang XX, et al. Diagnostics.7th ed.Beijing: People's Medical Publishing House, 2012: 382-383.
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24.	Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance[J]. Eur J Cardiothorac Surg, 2004, 25(5): 695-700. DOI: 10.1016/j.ejcts.2004.02.022.
25.	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.

1. 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.
2. Wang D, Ding X, He M, et al. Use of eye care services among diabetic patients in urban and rural China[J]. Ophthalmology, 2010, 117(9): 1755-1762. DOI: 10.1016/j.ophtha.2010.01.019.
3. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.Chinese Diabetes Society, Chinese Medical Association. Standards of care for type 2 diabetes in China(2017)[J]. Chin J Diabetes Mellitus, 2018, 10(1): 4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.
4. Kowalski A, Krikorian A, Lerma EV. Diabetic nephropathy for the primary care provider: new understandings on early detection and treatment[J]. Ochsner J, 2014, 14(3): 369-379.
5. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie house classification. ETDRS report number 10[J]. Ophthalmology, 1991, 98(5 Suppl): S786-806.
6. 姚晨, 陈峰.临床试验研究设计[M]//孙振球, 徐勇勇.医学统计学.4版.北京: 人民卫生出版社, 2014: 599-602.Yao C, Chen F.Clinical trail and study design[M]//Sun ZQ, Xu YY.Medical statistics.4th ed. Beijing: People's Medical Publishing House, 2012: 599-602.
7. Fox CS, Golden SH, Anderson C, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association[J]. Diabetes Care, 2015, 38(9): 1777-1803. DOI: 10.2337/dci15-0012.
8. Raman R, Gupta A, Kulothungan V, et al. Prevalence and risk factors of diabetic retinopathy in subjects with suboptimal glycemic, blood pressure and lipid control: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetic study (SN-DREAMS, Report 33)[J]. Curr Eye Res, 2012, 37(6): 513-523. DOI: 10.3109/02713683.2012.669005.
9. Voigt M, Schmidt S, Lehmann T, et al. Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes[J]. Exp Clin Endocrinol Diabetes, 2018, 126(9): 570-576. DOI: 10.1055/s-0043-120570.
10. Sabanayagam C, Yip W, Ting DS, et al. Ten emerging trends in the epidemiology of diabetic retinopathy[J]. Ophthalmic Epidemiol, 2016, 23(4): 209-222. DOI: 10.1080/09286586.2016.1193618.
11. 刘玉成.临床常用生物化学检测[M]//陈文彬, 潘祥林, 康熙雄, 等.诊断学.7版.北京: 人民卫生出版社, 2012: 382-383.Liu YC.Common clinical biochemical tests[M]//Chen WB, Pan XL, Kang XX, et al. Diagnostics.7th ed.Beijing: People's Medical Publishing House, 2012: 382-383.
12. American Diabetes Association. Standards of medical care in diabetes--2010[J]. Diabetes Care, 2010, 33 Suppl 1: S11-61. DOI: 10.2337/dc10-S011.
13. Toth PP, Simko RJ, Palli SR, et al. The impact of serum lipids on risk for microangiopathy in patients with type 2 diabetes mellitus[J]. Cardiovasc Diabetol, 2012, 11: 109. DOI: 10.1186/1475-2840-11-109.
14. Ankit BS, Mathur G, Agrawal RP, et al. Stronger relationship of serum apolipoprotein A-1 and B with diabetic retinopathy than traditional lipids[J]. Indian J Endocrinol Metab, 2017, 21(1): 102-105. DOI: 10.4103/2230-8210.196030.
15. Chang YC, Wu WC. Dyslipidemia and diabetic retinopathy[J]. Rev Diabet Stud, 2013, 10(2-3): 121-132. DOI: 10.1900/RDS.2013.10.121.
16. Maranhão RC, Carvalho PO, Strunz CC, et al. Lipoprotein (a): structure, pathophysiology and clinical implications[J]. Arq Bras Cardiol, 2014, 103(1): 76-84.
17. Maioli M, Tonolo G, Pacifico A, et al. Raised serum apolipoprotein (a) in active diabetic retinopathy[J]. Diabetologia, 1993, 36(1): 88-90. DOI: 10.1007/BF00399100.
18. Behl T, Velpandian T, Kotwani A. Role of altered coagulation-fibrinolytic system in the pathophysiology of diabetic retinopathy[J]. Vascul Pharmacol, 2017, 92: 1-5. DOI: 10.1016/j.vph.2017.03.005.
19. Zhong ZL, Han M, Chen S. Risk factors associated with retinal neovascularization of diabetic retinopathy in type 2 diabetes mellitus[J]. Int J Ophthalmol, 2011, 4(2): 182-185. DOI: 10.3980/j.issn.2222-3959.2011.02.15.
20. Zhang G, Chen H, Chen W, et al. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study[J]. Br J Ophthalmol, 2017, 101(12): 1591-1595. DOI: 10.1136/bjophthalmol-2017-310316.
21. Pedro RA, Ramon SA, Marc BB, et al. Prevalence and relationship between diabetic retinopathy and nephropathy, and its risk factors in the North-East of Spain, a population-based study[J]. Ophthalmic Epidemiol, 2010, 17(4): 251-265. DOI: 10.3109/09286586.2010.498661.
22. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism[J]. Diabetes, 2005, 54(6): 1615-1625. DOI: 10.2337/diabetes.54.6.1615.
23. Ghaffar T, Marwat ZI, Ullah F, et al. Association of serum total bilirubin level with diabetic retinopathy in type 2 diabetes mellitus[J]. J Ayub Med Coll Abbottabad, 2016, 28(3): 537-541.
24. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance[J]. Eur J Cardiothorac Surg, 2004, 25(5): 695-700. DOI: 10.1016/j.ejcts.2004.02.022.
25. 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.

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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