在2型糖尿病患者中,进展到扩散性糖尿病视网膜病变的时间
Iris M Kim1,2, Niloofar Radgoudarzi3,4, Evan M Chen1
1Department of Ophthalmology, University of California, San Francisco, San Francisco.
JAMA network open
|July 15, 2025
概括
生存模型可以预测2型糖尿病患者的增殖性糖尿病视网膜病变 (PDR) 的进展. 这些模型为早期检测和个性化护理提供了潜力,改善了卫生资源的分配.
科学领域:
- 眼科医生 眼科 眼科
- 内分泌学 在内分泌学.
- 数据科学数据科学数据科学
背景情况:
- 糖尿病视网膜病变 (DR) 的进展,特别是扩散性糖尿病视网膜病变 (PDR),需要有效的风险分层,以便及时干预.
- 早期识别患有PDR进展高风险的患者对于有效的医疗资源分配和改善患者治疗结果至关重要.
- 2型糖尿病 (T2DM) 是导致视力丧失的主要原因,而PDR是一种危及视力的并发症.
研究的目的:
- 开发和验证生存模型,以预测T2DM患者的PDR进展情况.
- 通过使用电子健康记录数据,确定与PDR进展相关的关键风险因素.
- 评估不同生存模型的预测性能和校准.
主要方法:
- 从2012年3月到2024年7月,利用UC健康数据仓库 (UCHDW) 的非身份电子健康记录进行预后研究.
- 纳入标准:年龄≥18岁的患有非增殖性糖尿病视网膜病变 (NPDR) 或糖尿病黄斑 (DME) 和T2DM的患者.
- 三种生存模型 (Cox回归,Lasso-Cox和随机生存森林) 在内部和外部测试集上被开发和验证.
主要成果:
- 这项研究包括7739名参与者;9.3%的患者在平均1.89年内经历了PDR进展.
- 所有开发的生存模型都在内部和外部测试集上显示出良好的预测歧视 (C指数:0.73-0.75).
- PDR进展的关键预测因素包括基线年龄,种族,种族,DME,NPDR严重程度,HbA1c水平和糖尿病病.
结论:
- 经过验证的生存模型对T2DM患者的PDR进展表现出强大的预测能力.
- 这些模型显示高达2年的良好校准,表明短期风险评估的可靠性.
- 这些发现支持这些模型在早期PDR风险识别,个性化患者随访和优化资源配置方面的潜力.
相关概念视频
Diabetes Mellitus: Type 2 and Gestational
2.9K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.9K
Diabetes: Symptoms, Diagnosis, and Complications
684
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
684
Pathophysiology of Diabetes
1.2K
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
1.2K
Carbohydrate Metabolism
11.7K
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
11.7K
Diabetes Mellitus: Overview and Type I Subtype
3.2K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
3.2K
Diabetes: Management and Pharmacotherapy
354
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
354


