The Importance of Close Follow-Up in Patients with Early-Grade Diabetic Retinopathy: A Taiwan Population-Based Study Grading via Deep Learning Model
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population
2.2. DLM for Grading Diabetic Retinopathy
2.3. Statistical Analysis and Model Performance Assessment
3. Results
3.1. Prevalence of Different Grades of DR
3.2. Effect of HbA1c on DR Progression
3.3. Effect of Initial Grade on DR Progression
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No DR (n = 1046) | Mild NPDR (n = 480) | Moderate NPDR (n = 756) | Severe NPDR (n = 282) | PDR (n = 59) | p-Value | |
---|---|---|---|---|---|---|
Basic characteristics | ||||||
Gender | 0.176 | |||||
Female | 506 (48.4%) | 215 (44.8%) | 328 (43.4%) | 129 (45.7%) | 32 (54.2%) | |
Male | 540 (51.6%) | 265 (55.2%) | 428 (56.6%) | 153 (54.3%) | 27 (45.8%) | |
Age | 63.85 ± 13.22 | 63.24 ± 12.45 | 59.65 ± 11.35 | 57.93 ± 11.81 | 56.66 ± 12.49 | <0.001 |
Height (cm) | 162.40 ± 8.59 | 162.21 ± 8.97 | 162.47 ± 8.73 | 162.56 ± 9.15 | 161.92 ± 9.08 | 0.968 |
Weight (kg) | 67.77 ± 13.85 | 67.82 ± 14.02 | 67.81 ± 13.72 | 68.83 ± 15.08 | 68.79 ± 12.96 | 0.806 |
Body mass index | 25.59 ± 4.27 | 25.74 ± 4.94 | 25.59 ± 4.27 | 25.91 ± 4.66 | 26.14 ± 3.92 | 0.697 |
SBP (mmHg) | 139.02 ± 20.33 | 140.19 ± 21.56 | 141.31 ± 22.37 | 140.05 ± 22.93 | 144.76 ± 26.41 | 0.102 |
DBP (mmHg) | 79.32 ± 12.15 | 78.20 ± 11.54 | 79.80 ± 12.75 | 80.09 ± 12.63 | 81.64 ± 15.08 | 0.084 |
Comorbidity | ||||||
Hypertension | 376 (35.9%) | 194 (40.4%) | 290 (38.3%) | 112 (39.7%) | 25 (42.4%) | 0.416 |
Ischemic heart disease | 234 (22.4%) | 119 (24.8%) | 170 (22.5%) | 70 (24.8%) | 7 (11.9%) | 0.208 |
Stroke | 139 (13.3%) | 64 (13.3%) | 109 (14.4%) | 30 (10.6%) | 8 (13.6%) | 0.641 |
Diabetic neuropathy | 65 (6.2%) | 47 (9.8%) | 73 (9.6%) | 19 (6.7%) | 11 (18.6%) | 0.001 |
Laboratory test | ||||||
HbA1c (%) | 7.65 ± 1.87 | 7.96 ± 1.85 | 8.30 ± 2.05 | 8.40 ± 2.20 | 8.01 ± 2.05 | <0.001 |
Fasting glucose (mg/dL) | 142.11 ± 54.96 | 144.54 ± 52.14 | 154.47 ± 62.63 | 153.02 ± 62.83 | 148.37 ± 64.99 | <0.001 |
Triglyceride (mg/dL) | 150.33 ± 102.70 | 160.32 ± 130.04 | 161.75 ± 129.51 | 160.62 ± 138.91 | 158.69 ± 99.36 | 0.284 |
Total cholesterol (mg/dL) | 170.36 ± 41.25 | 168.40 ± 46.84 | 171.55 ± 44.40 | 172.40 ± 46.86 | 179.27 ± 62.02 | 0.375 |
LDL (mg/dL) | 99.43 ± 33.94 | 98.50 ± 36.38 | 99.94 ± 35.95 | 101.51 ± 36.32 | 107.46 ± 49.14 | 0.388 |
HDL (mg/dL) | 46.90 ± 12.95 | 45.62 ± 12.23 | 45.57 ± 12.46 | 45.01 ± 12.68 | 48.32 ± 13.49 | 0.039 |
Creatinine (mg/dL) | 1.31 ± 1.60 | 1.59 ± 1.95 | 1.68 ± 2.02 | 1.59 ± 1.72 | 1.93 ± 2.37 | <0.001 |
ALT (U/L) | 23.37 ± 20.28 | 23.62 ± 25.94 | 23.84 ± 39.17 | 22.32 ± 21.39 | 20.64 ± 12.46 | 0.877 |
Hemoglobin (g/dL) | 13.02 ± 1.87 | 12.58 ± 2.00 | 12.36 ± 2.10 | 12.38 ± 2.04 | 11.62 ± 2.04 | <0.001 |
White blood cell (103/uL) | 7.32 ± 2.77 | 7.54 ± 2.95 | 7.83 ± 6.40 | 7.54 ± 2.48 | 7.24 ± 2.45 | 0.138 |
Platelets (103/uL) | 212.06 ± 73.80 | 213.44 ± 72.56 | 221.54 ± 78.57 | 224.32 ± 66.05 | 220.17 ± 79.28 | 0.024 |
HbA1c ≤ 6.7% (n = 799) | 6.7% < HbA1c ≤ 8.2% (n = 891) | 8.2% < HbA1c (n = 933) | p-Value | |
---|---|---|---|---|
Basic characteristics | ||||
Gender | 0.309 | |||
Female | 358 (44.8%) | 403 (45.2%) | 449 (48.1%) | |
Male | 441 (55.2%) | 488 (54.8%) | 484 (51.9%) | |
Age | 62.08 ± 12.80 | 64.26 ± 11.38 | 59.01 ± 13.03 | <0.001 |
Height (cm) | 162.33 ± 9.00 | 162.56 ± 8.28 | 162.29 ± 9.02 | 0.786 |
Weight (kg) | 66.84 ± 13.47 | 68.07 ± 13.78 | 68.71 ± 14.48 | 0.020 |
Body mass index | 25.26 ± 4.07 | 25.67 ± 4.39 | 26.01 ± 4.74 | 0.002 |
SBP (mmHg) | 138.39 ± 21.07 | 140.41 ± 20.78 | 141.36 ± 22.73 | 0.016 |
DBP (mmHg) | 78.59 ± 12.01 | 78.80 ± 11.89 | 80.64 ± 12.97 | 0.001 |
Comorbidity | ||||
Hypertension | 311 (38.9%) | 341 (38.3%) | 345 (36.9%) | 0.682 |
Ischemic heart disease | 187 (23.4%) | 236 (26.5%) | 177 (19.0%) | 0.001 |
Stroke | 101 (12.6%) | 117 (13.1%) | 132 (14.1%) | 0.644 |
Diabetic neuropathy | 61 (7.6%) | 63 (7.1%) | 91 (9.7%) | 0.090 |
Laboratory test | ||||
HbA1c (%) | 6.12 ± 0.43 | 7.41 ± 0.42 | 10.12 ± 1.69 | <0.001 |
Fasting glucose (mg/dL) | 124.15 ± 33.53 | 138.02 ± 41.28 | 176.33 ± 74.30 | <0.001 |
Triglyceride (mg/dL) | 134.53 ± 106.32 | 145.88 ± 86.40 | 186.12 ± 149.67 | <0.001 |
Total cholesterol (mg/dL) | 164.57 ± 39.09 | 166.30 ± 41.32 | 180.32 ± 49.60 | <0.001 |
LDL (mg/dL) | 96.19 ± 33.29 | 96.09 ± 32.47 | 106.46 ± 39.34 | <0.001 |
HDL (mg/dL) | 46.54 ± 12.86 | 46.45 ± 12.65 | 45.42 ± 12.53 | 0.117 |
Creatinine (mg/dL) | 1.62 ± 2.08 | 1.47 ± 1.70 | 1.45 ± 1.74 | 0.107 |
ALT (U/L) | 22.53 ± 20.98 | 23.07 ± 18.91 | 24.39 ± 38.45 | 0.355 |
Hemoglobin (g/dL) | 12.42 ± 2.06 | 12.64 ± 1.96 | 12.86 ± 2.00 | <0.001 |
White blood cell (103/uL) | 7.26 ± 4.73 | 7.47 ± 4.66 | 7.82 ± 2.93 | 0.018 |
Platelets (103/uL) | 203.70 ± 70.38 | 212.64 ± 69.60 | 231.26 ± 79.68 | <0.001 |
Crude-HR (95% CI) | p-Value | Adjusted-HR (95% CI) | p-Value | |
---|---|---|---|---|
Initial grade | <0.001 | <0.001 | ||
No DR | 1.00 | 1.00 | ||
Mild NPDR | 2.00 (1.72–2.32) | <0.001 | 1.95 (1.68–2.27) | <0.001 |
Moderate NPDR | 1.82 (1.58–2.09) | <0.001 | 1.73 (1.50–1.99) | <0.001 |
Severe NPDR | 0.87 (0.69–1.09) | 0.223 | 0.82 (0.65–1.03) | 0.082 |
Basic characteristics | ||||
Gender | 0.019 | 0.042 | ||
Female | 1.00 | 1.00 | ||
Male | 1.15 (1.02–1.29) | 0.019 | 1.13 (1.00–1.27) | 0.042 |
Age | 0.95 (0.90–1.01) | 0.076 | 0.97 (0.91–1.03) | 0.275 |
Height | 1.06 (1.00–1.12) | 0.057 | 1.05 (0.99–1.12) | 0.095 |
Weight | 1.02 (0.96–1.08) | 0.474 | 1.08 (0.97–1.22) | 0.169 |
Body mass index | 1.00 (0.94–1.06) | 0.876 | 0.99 (0.94–1.05) | 0.802 |
SBP | 1.03 (0.97–1.09) | 0.309 | 1.02 (0.96–1.08) | 0.542 |
DBP | 1.04 (0.98–1.10) | 0.201 | 1.03 (0.97–1.10) | 0.287 |
Comorbidity | ||||
Hypertension | 1.11 (0.99–1.25) | 0.087 | 1.08 (0.96–1.22) | 0.197 |
Ischemic heart disease | 1.06 (0.92–1.21) | 0.417 | 1.07 (0.94–1.23) | 0.319 |
Stroke | 1.15 (0.97–1.35) | 0.104 | 1.11 (0.94–1.31) | 0.203 |
Diabetic neuropathy | 1.23 (1.01–1.50) | 0.043 | 1.11 (0.91–1.36) | 0.311 |
Laboratory test | ||||
HbA1c | 1.13 (1.08–1.20) | <0.001 | 1.11 (1.05–1.17) | <0.001 |
Fasting glucose | 1.04 (0.98–1.10) | 0.173 | 0.97 (0.91–1.03) | 0.302 |
Triglyceride | 1.01 (0.95–1.06) | 0.784 | 0.97 (0.91–1.03) | 0.343 |
Total cholesterol | 1.00 (0.94–1.06) | 0.966 | 0.98 (0.92–1.04) | 0.537 |
LDL cholesterol | 1.01 (0.95–1.08) | 0.682 | 0.99 (0.93–1.06) | 0.821 |
HDL cholesterol | 0.95 (0.90–1.01) | 0.101 | 0.98 (0.92–1.04) | 0.458 |
Creatinine | 1.05 (1.00–1.11) | 0.061 | 1.02 (0.96–1.07) | 0.568 |
ALT | 0.87 (0.79–0.96) | 0.005 | 0.86 (0.79–0.95) | 0.003 |
Hemoglobin | 0.89 (0.84–0.94) | <0.001 | 0.91 (0.86–0.96) | 0.001 |
White blood cell | 1.06 (1.01–1.11) | 0.022 | 1.04 (0.99–1.09) | 0.159 |
Platelets | 1.06 (1.00–1.12) | 0.037 | 1.04 (0.98–1.10) | 0.199 |
Crude-HR (95% CI) | p-Value | Adjusted-HR (95% CI) | p-Value | |
---|---|---|---|---|
Initial grade | <0.001 | <0.001 | ||
No DR | 1.00 | 1.00 | ||
Mild NPDR | 13.83 (6.19–30.93) | <0.001 | 13.58 (6.07–30.39) | <0.001 |
Moderate NPDR | 25.06 (11.61–54.08) | <0.001 | 23.09 (10.68–49.91) | <0.001 |
Severe NPDR | 62.29 (28.87–134.40) | <0.001 | 55.24 (25.54–119.46) | <0.001 |
Basic characteristics | ||||
Gender | 0.422 | 0.750 | ||
Female | 1.00 | 1.00 | ||
Male | 1.11 (0.86–1.44) | 0.422 | 0.96 (0.74–1.25) | 0.750 |
Age | 0.67 (0.60–0.76) | <0.001 | 0.73 (0.63–0.84) | <0.001 |
Height | 1.04 (0.92–1.19) | 0.522 | 0.97 (0.84–1.12) | 0.671 |
Weight | 0.98 (0.86–1.12) | 0.789 | 0.93 (0.71–1.20) | 0.569 |
Body mass index | 0.95 (0.83–1.09) | 0.470 | 0.91 (0.79–1.03) | 0.146 |
SBP | 1.10 (0.97–1.25) | 0.137 | 1.11 (0.98–1.25) | 0.111 |
DBP | 1.23 (1.08–1.40) | 0.001 | 1.15 (1.01–1.31) | 0.038 |
Comorbidity | ||||
Hypertension | 1.18 (0.91–1.54) | 0.210 | 1.11 (0.86–1.45) | 0.421 |
Ischemic heart disease | 1.13 (0.84–1.52) | 0.414 | 1.11 (0.82–1.50) | 0.498 |
Stroke | 1.61 (1.16–2.25) | 0.005 | 1.72 (1.23–2.40) | 0.001 |
Diabetic neuropathy | 1.45 (0.95–2.21) | 0.087 | 1.15 (0.75–1.78) | 0.519 |
Laboratory test | ||||
HbA1c | 1.30 (1.16–1.46) | <0.001 | 1.09 (0.97–1.22) | 0.164 |
Fasting glucose | 1.13 (1.01–1.26) | 0.032 | 0.93 (0.82–1.06) | 0.263 |
Triglyceride | 1.05 (0.94–1.17) | 0.397 | 1.01 (0.91–1.12) | 0.878 |
Total cholesterol | 1.01 (0.88–1.16) | 0.916 | 0.93 (0.81–1.07) | 0.305 |
LDL | 1.00 (0.87–1.14) | 0.963 | 0.89 (0.78–1.03) | 0.120 |
HDL | 0.84 (0.74–0.97) | 0.017 | 0.88 (0.76–1.01) | 0.069 |
Creatinine | 1.17 (1.05–1.29) | 0.003 | 1.11 (0.99–1.23) | 0.062 |
ALT | 0.89 (0.72–1.10) | 0.285 | 0.92 (0.76–1.12) | 0.425 |
Hemoglobin | 0.74 (0.65–0.84) | <0.001 | 0.84 (0.74–0.96) | 0.008 |
White blood cell | 1.08 (0.97–1.21) | 0.148 | 1.03 (0.89–1.19) | 0.686 |
Platelets | 1.14 (1.01–1.28) | 0.033 | 1.05 (0.92–1.20) | 0.493 |
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Lee, C.-C.; Hsing, S.-C.; Lin, Y.-T.; Lin, C.; Chen, J.-T.; Chen, Y.-H.; Fang, W.-H. The Importance of Close Follow-Up in Patients with Early-Grade Diabetic Retinopathy: A Taiwan Population-Based Study Grading via Deep Learning Model. Int. J. Environ. Res. Public Health 2021, 18, 9768. https://doi.org/10.3390/ijerph18189768
Lee C-C, Hsing S-C, Lin Y-T, Lin C, Chen J-T, Chen Y-H, Fang W-H. The Importance of Close Follow-Up in Patients with Early-Grade Diabetic Retinopathy: A Taiwan Population-Based Study Grading via Deep Learning Model. International Journal of Environmental Research and Public Health. 2021; 18(18):9768. https://doi.org/10.3390/ijerph18189768
Chicago/Turabian StyleLee, Chia-Cheng, Shi-Chue Hsing, Yu-Ting Lin, Chin Lin, Jiann-Torng Chen, Yi-Hao Chen, and Wen-Hui Fang. 2021. "The Importance of Close Follow-Up in Patients with Early-Grade Diabetic Retinopathy: A Taiwan Population-Based Study Grading via Deep Learning Model" International Journal of Environmental Research and Public Health 18, no. 18: 9768. https://doi.org/10.3390/ijerph18189768