Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Nov 1;10(1):288.
doi: 10.1186/s13643-021-01841-z.

Prognostic models of diabetic microvascular complications: a systematic review and meta-analysis

Sigit Ari Saputro  1   2 , Oraluck Pattanaprateep  3 , Anuchate Pattanateepapon  1 , Swekshya Karmacharya  1 , Ammarin Thakkinstian  1
Affiliations
Meta-Analysis

Prognostic models of diabetic microvascular complications: a systematic review and meta-analysis

Sigit Ari Saputro et al. Syst Rev. .

Abstract

Background: Many prognostic models of diabetic microvascular complications have been developed, but their performances still varies. Therefore, we conducted a systematic review and meta-analysis to summarise the performances of the existing models.

Methods: Prognostic models of diabetic microvascular complications were retrieved from PubMed and Scopus up to 31 December 2020. Studies were selected, if they developed or internally/externally validated models of any microvascular complication in type 2 diabetes (T2D).

Results: In total, 71 studies were eligible, of which 32, 30 and 18 studies initially developed prognostic model for diabetic retinopathy (DR), chronic kidney disease (CKD) and end stage renal disease (ESRD) with the number of derived equations of 84, 96 and 51, respectively. Most models were derived-phases, some were internal and external validations. Common predictors were age, sex, HbA1c, diabetic duration, SBP and BMI. Traditional statistical models (i.e. Cox and logit regression) were mostly applied, otherwise machine learning. In cohorts, the discriminative performance in derived-logit was pooled with C statistics of 0.82 (0.73‑0.92) for DR and 0.78 (0.74‑0.83) for CKD. Pooled Cox regression yielded 0.75 (0.74‑0.77), 0.78 (0.74‑0.82) and 0.87 (0.84‑0.89) for DR, CKD and ESRD, respectively. External validation performances were sufficiently pooled with 0.81 (0.78‑0.83), 0.75 (0.67‑0.84) and 0.87 (0.85‑0.88) for DR, CKD and ESRD, respectively.

Conclusions: Several prognostic models were developed, but less were externally validated. A few studies derived the models by using appropriate methods and were satisfactory reported. More external validations and impact analyses are required before applying these models in clinical practice.

Systematic review registration: PROSPERO CRD42018105287.

Keywords: Meta-analysis; Microvascular complications; Prognostic model; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot of C statistics in derivative phase for DR
Fig. 2
Fig. 2
Forest plot of C statistics in derivative phase for CKD
Fig. 3
Fig. 3
Forest plot of C statistics in derivative phase for ESRD
See this image and copyright information in PMC

References

    1. International Diabetes Federation . IDF Diabetes Atlas Ninth Edition 2019. Brussels: International Diabetes Federation; 2019.
    1. World Health Organization . Classification of diabetes mellitus. Geneva: World Health Organization; 2019.
    1. Dougherty T, Heile M. Type 2 diabetes in the US managed care setting: the burden of disease and rationale for an oral glucagon-like peptide-1 receptor agonist. Am J Manag Care. 2020;26(16 Suppl):S325–Ss34. - PubMed
    1. Ahmad J. Management of diabetic nephropathy: recent progress and future perspective. Diabetes Metab Syndr. 2015;9(4):343–358. doi: 10.1016/j.dsx.2015.02.008. - DOI - PubMed
    1. American Diabetes Association Microvascular complications and foot care: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S135–Ss51. doi: 10.2337/dc20-S011. - DOI - PubMed

MeSH terms