Nomogram for prediction of non-proliferative diabetic retinopathy in juvenile-onset type 1 diabetes: a cohort study in an Asian population

Abstract

The need for screening for retinopathy in patients with type 1 diabetes mellitus (T1DM) has been emphasised, but diagnostic delays were reported when screening was done at fixed intervals. To establish an individualised risk-prediction model to assist screening non-proliferative diabetic retinopathy (NPDR) in T1DM, we performed a retrospective cohort study enrolling participants in the Chang Gung Juvenile Diabetes Eye Study. There were 413 patients with 12 381 records analysed from 2005 to 2015. A time-dependent Cox proportional hazard analysis was used to evaluate the risks of NPDR development and a nomogram with risk-stratification indicators was established based on the results. During 97 months of follow-up, 43 of 413 patients (10.4%) developed NPDR. Male sex (HR: 0.4, 95% CI: 0.19–0.85), age 5–14 years at onset of T1DM (6.38, 2.41–16.87), duration of diabetes (1.57, 1.41–1.75), and hemoglobin A1c level (1.56, 1.35–1.80) were independently associated with NPDR. Using the nomogram offers a quick method in the clinical setting to interpret the risk of NPDR development. Based on its weighting, each of the independent factors is allocated a score, and the total points indicate the probabilities of NPDR occurring within 6 months, 1 year, and 3 years.

Nomogram Prediction Model for Diabetic Retinopathy Development in Type 2 Diabetes Mellitus Patients: A Retrospective Cohort Study

“…However, researches on the subject have been mostly restricted to limited ability that were only able to predict the current risk of DR but not the future risks. It is been shown that the nomogram based on sex, age, duration of diabetes, and HbA1c could be used to predict NPDR development within 6 months, 1 year, and 3 years in type 1 diabetes mellitus (T1DM) population [ 22 ], but the utility of nomogram for predicting DR development in T2DM patients has not been well documented. In this cohort study, through the Cox regressions analyzing the relationships between systemic baseline characteristics and events of DR development at endpoint, we constructed the risk nomogram of DR development after 3, 4, and 5 years in T2DM patients.…”

<p>Glycosylated Hemoglobin A1c Improves the Performance of the Nomogram for Predicting the 5-Year Incidence of Type 2 Diabetes</p>

“…HbA1c can be used as a predictor of T2DM, gestational diabetes, diabetic complication and response to diabetes medication. [9][10][11][12] Krabbe et al found that the power of risk scores and HbA1c for predicting the risk of incident T2DM were similar. 5 A more extensive prospective open cohort study conducted in England found that either FPG or HbA1c could elevate the discrimination of a predictive model for 10-year risk of T2DM.…”

Clinical and Demographic Factors Associated With Diabetic Retinopathy Among Young Patients With Diabetes

“…Studies have examined the prevalence of both pediatric and adult DR in multiple countries, 1,[8][9][10][11][12][13][14][15] but within the US, the largest studies have focused on adults with diabetes. 16 Although large pediatric cohorts from countries with national diabetes registries have been examined, 17 US children, adolescents, and young adults are an increasing and diverse group who are not well represented by these studies.…”