Enhanced prediction of abnormal glucose tolerance using an extended non-invasive risk score incorporating routine renal biochemistry.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-02-19 DOI:10.1136/bmjdrc-2023-003768
Jie He, Baoqi Fan, Eric S H Lau, Natural Chu, Noel Yat Hey Ng, Kathy Ho Ting Leung, Emily W M Poon, Alice Pik Shan Kong, Ronald Ching Wan Ma, Andrea O Y Luk, Juliana C N Chan, Elaine Chow
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Abstract

Introduction: Type 2 diabetes is preventable in subjects with impaired glucose tolerance based on 2-hour plasma glucose (2hPG) during 75 g oral glucose tolerance test (OGTT). We incorporated routine biochemistry to improve the performance of a non-invasive diabetes risk score to identify individuals with abnormal glucose tolerance (AGT) defined by 2hPG≥7.8 mmol/L during OGTT.

Research design and methods: We used baseline data of 1938 individuals from the community-based "Better Health for Better Hong Kong - Hong Kong Family Diabetes Study (BHBHK-HKFDS) Cohort" recruited in 1998-2003. We incorporated routine biochemistry in a validated non-invasive diabetes risk score, and evaluated its performance using area under receiver operating characteristics (AUROC) with internal and external validation.

Results: The AUROC of the original non-invasive risk score to predict AGT was 0.698 (95% CI, 0.662 to 0.733). Following additional inclusion of fasting plasma glucose, serum potassium, creatinine, and urea, the AUROC increased to 0.778 (95% CI, 0.744 to 0.809, p<0.001). Net reclassification improved by 31.9% (p<0.001) overall, by 30.8% among people with AGT and 1.1% among people without AGT. The extended model showed good calibration (χ2=11.315, p=0.1845) and performance on external validation using an independent data set (AUROC=0.722, 95% CI, 0.680 to 0.764).

Conclusions: The extended risk score incorporating clinical and routine biochemistry can be integrated into an electronic health records system to select high-risk subjects for evaluation of AGT using OGTT for prevention of diabetes.

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使用包含常规肾脏生化指标的扩展无创风险评分,加强对糖耐量异常的预测。
导言:根据 75 克口服葡萄糖耐量试验(OGTT)中的 2 小时血浆葡萄糖(2hPG),糖耐量受损的受试者可预防 2 型糖尿病。我们结合常规生化指标,改进了无创糖尿病风险评分的性能,以识别糖耐量异常(AGT)患者,其定义是在 OGTT 期间 2hPG≥7.8 mmol/L:我们使用了1998年至2003年期间在社区进行的 "健康香港 - 香港家庭糖尿病研究(BHBHK-HKFDS)"队列中1938人的基线数据。我们将常规生化指标纳入经过验证的无创糖尿病风险评分中,并通过内部和外部验证,使用接收者操作特征下面积(AUROC)对其性能进行了评估:原始无创风险评分预测 AGT 的 AUROC 为 0.698(95% CI,0.662 至 0.733)。在额外加入空腹血浆葡萄糖、血清钾、肌酐和尿素后,AUROC 增加到 0.778(95% CI,0.744 至 0.809,p2=11.315,p=0.1845),并且在使用独立数据集进行外部验证时表现良好(AUROC=0.722,95% CI,0.680 至 0.764):结合临床和常规生化指标的扩展风险评分可整合到电子健康记录系统中,用于选择高风险受试者,利用OGTT评估AGT以预防糖尿病。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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