| アブストラクト | BACKGROUND: Delayed diagnosis and treatment of sight threatening diabetic retinopathy (STDR) is a common cause of visual impairment in people with Type 2 diabetes. Therefore, systematic regular retinal screening is recommended, but global coverage of such services is challenging. We aimed to develop and validate predictive models for STDR to identify 'at-risk' population for retinal screening. METHODS: Models were developed using datasets obtained from general practices in inner London, United Kingdom (UK) on adults with type 2 Diabetes during the period 2007-2017. Three models were developed using Cox regression and model performance was assessed using C statistic, calibration slope and observed to expected ratio measures. Models were externally validated in cohorts from Wales, UK and India. FINDINGS: A total of 40,334 people were included in the model development phase of which 1427 (3.54%) people developed STDR. Age, gender, diabetes duration, antidiabetic medication history, glycated haemoglobin (HbA1c), and history of retinopathy were included as predictors in the Model 1, Model 2 excluded retinopathy status, and Model 3 further excluded HbA1c. All three models attained strong discrimination performance in the model development dataset with C statistics ranging from 0.778 to 0.832, and in the external validation datasets (C statistic 0.685 - 0.823) with calibration slopes closer to 1 following re-calibration of the baseline survival. INTERPRETATION: We have developed new risk prediction equations to identify those at risk of STDR in people with type 2 diabetes in any resource-setting so that they can be screened and treated early. Future testing, and piloting is required before implementation. FUNDING: This study was funded by the GCRF UKRI (MR/P207881/1) and supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. |
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| ジャーナル名 | EClinicalMedicine |
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| 投稿日 | 2022/7/29 |
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| 投稿者 | Nugawela, Manjula D; Gurudas, Sarega; Prevost, A Toby; Mathur, Rohini; Robson, John; Sathish, Thirunavukkarasu; Rafferty, J M; Rajalakshmi, Ramachandran; Anjana, Ranjit Mohan; Jebarani, Saravanan; Mohan, Viswanathan; Owens, David R; Sivaprasad, Sobha |
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| 組織名 | UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, United;Kingdom.;King's College London, Nightingale-Saunders Clinical Trials and Epidemiology;Unit, London SE5 9PJ, United Kingdom.;London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT,;United Kingdom.;Queen Mary University of London, Institute of Population Health Sciences, London,;E1 4NS Wales, United Kingdom.;Population Health Research Institute, McMaster University, Hamilton, ON, Canada.;Department of Primary Care and Public Health, Imperial College London, London,;UK.;Swansea University Medical School, Swansea University, Singleton Park, Swansea,;Wales SA2 8PP, United Kingdom.;Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre,;Chennai 600086, India.;Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35898318/ |
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