To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study.

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & Metabolism Journal Pub Date : 2024-10-31 DOI:10.4093/dmj.2024.0142
Jinxiao Lian, Ching So, Sarah Morag McGhee, Thuan-Quoc Thach, Cindy Lo Kuen Lam, Colman Siu Cheung Fung, Alfred Siu Kei Kwong, Jonathan Cheuk Hung Chan
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Abstract

Background: The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals.

Methods: The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve.

Results: Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females.

Conclusion: The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people.

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确定基于风险的糖尿病视网膜病变筛查间隔:从回顾性队列研究中开发和验证风险算法。
背景:糖尿病视网膜病变(DR)的最佳筛查间隔仍存在争议。本研究旨在开发一种风险算法,以预测以华人为主的人群发生可转诊的危及视力的糖尿病视网膜病变(STDR)的个体风险,并为基于风险的筛查间隔期提供证据:方法:研究人员纳入了2010年至2016年期间在香港接受系统性糖尿病视网膜病变筛查的117418名受试者的回顾性队列数据,利用参数生存模型开发并验证了风险算法。该风险算法可用于预测特定时间间隔内STDR的个体风险,或达到特定风险边际的时间,从而分配筛查间隔。通过比较 2 年内累积 STDR 事件与预测风险来评估校准性能,并使用接收器操作特征曲线(ROC)进行判别:风险算法中包括糖尿病病程、糖化血红蛋白、收缩压、慢性肾病、糖尿病药物和年龄。预测结果的验证表明,男性(5.6% 对 5.1%,P=0.724)或女性(4.8% 对 4.6%,P=0.099)预测的 STDR 风险与观察到的 STDR 风险之间没有显著差异。男性的接收者操作特征曲线下面积为0.80(95%置信区间[CI],0.78至0.81),女性的接收者操作特征曲线下面积为0.81(95%置信区间[CI],0.79至0.83):风险算法对可转诊 STDR 具有良好的预测效果。使用基于风险的筛查间隔,我们可以将更多的筛查次数分配给高风险人群,同时减少低风险人群的筛查次数。
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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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