1School of Optometry, The Hong Kong Polytechnic University, Hong Kong
2School of Public Health, The University of Hong Kong, Hong Kong
3Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
4Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong
5Department of Ophthalmology, The University of Hong Kong, Hong Kong
Copyright © 2024 Korean Diabetes Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conception or design: J.L., S.M.M., T.T., C.L.K.L., J.C.H.C.
Acquisition, analysis, or interpretation of data: all authors.
Drafting the work or revising: all authors.
Final approval of the manuscript: all authors.
FUNDING
This work was supported by the Health and Medical Research Fund (HMRF) of the Hong Kong SAR Government (grant number 14151971). The funding organization had no role in the design or conduct of this research.
Characteristic | Derivation (n=78,279) | Validation (n=39,139) | P valuea |
---|---|---|---|
Sex | 0.841 | ||
Male | 36,842 (47.1) | 18,445 (47.1) | |
Female | 41,437 (52.9) | 20,694 (52.9) | |
Age, yr | 62.5±10.6 | 62.4±10.5 | 0.085 |
Duration of diabetes, yr | 5.7±5.9 | 5.8±5.9 | 0.280 |
Receiving CSSA | 5,521 (7.1) | 2,718 (6.9) | 0.493 |
Smoking habit | 0.664 | ||
Never-smoker (includes passive smoker) | 53,117 (67.9) | 26,688 (68.2) | |
Current smoker | 8,379 (10.7) | 4,150 (10.6) | |
Ex-smoker | 12,307 (15.7) | 6,062 (15.5) | |
Missing/Not known | 4,476 (5.7) | 2,239 (5.7) | |
Age, yr | 0.159 | ||
Non-drinker | 53,539 (68.4) | 26,949 (68.9) | |
Current drinker | 2,539 (3.2) | 1,247 (3.2) | |
Social drinker | 12,402 (15.8) | 5,993 (15.3) | |
Ex-drinker | 4,769 (6.1) | 2,439 (6.2) | |
Missing/Not known | 5,030 (6.4) | 2,511 (6.4) | |
Clinical parameters | |||
Diabetes type | 0.510 | ||
Type 1 diabetes mellitus | 86 (0.1) | 43 (0.1) | |
Type 2 diabetes mellitus | 77,789 (99.4) | 38,883 (99.3) | |
Otherb | 171 (0.2) | 78 (0.2) | |
Missing | 233 (0.3) | 135 (0.3) | |
Diabetic retinopathy status at baseline | 0.006 | ||
R0 | 51,057 (65.2) | 25,844 (66.0) | |
R1 | 27,222 (34.8) | 13,295 (34.0) | |
Body mass index, kg/m2 | 25.9±4.0 | 25.9±4.0 | 0.401 |
Systolic blood pressure, mm Hg | 132.7±15.4 | 132.5±15.4 | 0.022 |
Diastolic blood pressure, mm Hg | 74.8±9.7 | 74.8±9.7 | 0.279 |
HbA1c, % | 7.2±1.3 | 7.2±1.3 | 0.185 |
Total cholesterol, mmol/L | 4.7±0.9 | 4.7±0.9 | 0.243 |
HDL-C, mmol/L | 1.3±0.3 | 1.3±0.3 | 0.790 |
LDL-C, mmol/L | 2.7±0.8 | 2.7±0.8 | 0.197 |
eGFR, mL/min/1.73 m2 | 87.0±21.9 | 87.0±21.9 | 0.921 |
UACR, mg/mmol | 5.6±22.5 | 5.5±22.7 | 0.469 |
Presence of CKDc | 17,911 (29.6) | 8,834 (29.1) | 0.091 |
Medication | |||
Oral diabetes drug | 62,325 (79.6) | 31,160 (79.6) | 0.983 |
Insulin | 2,033 (2.6) | 949 (2.4) | 0.077 |
Hypertensive drug | 59,329 (75.8) | 29,690 (75.9) | 0.803 |
Lipid drug | 32,619 (41.7) | 16,327 (41.7) | 0.882 |
History of complication | |||
End-stage renal disease | 93 (0.1) | 51 (0.1) | 0.596 |
Cardiovascular disease | 5,816 (7.4) | 3,010 (7.7) | 0.110 |
Coronary heart disease | 2,593 (3.3) | 1,382 (3.5) | 0.051 |
Heart failure | 322 (0.4) | 160 (0.4) | 0.949 |
Stroke | 3,168 (4.0) | 1,609 (4.1) | 0.601 |
Neuropathy | 130 (0.2) | 78 (0.2) | 0.202 |
Values are presented as number (%) or mean±standard deviation.
RAMP-DM, The Risk Assessment and Management Programme–Diabetes Mellitus; CSSA, comprehensive social security assistance; R0, no diabetic retinopathy; R1, background diabetic retinopathy in at least one eye; HbA1c, glycosylated hemoglobin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; UACR, urine albumin-to-creatinine ratio; CKD, chronic kidney disease.
a T-test for continuous variables, chi-square test for categorical variables,
b Other: gestational or unclassified;
c Classification of CKD: eGFR <60 mL/min/1.73 m2 or UACR ≥3 mg/mmol from Kidney Disease Improving Global Outcomes 2012 guideline.
Characteristic | Derivation (n=78,279) | Validation (n=39,139) | P value |
---|---|---|---|
Sex | 0.841 | ||
Male | 36,842 (47.1) | 18,445 (47.1) | |
Female | 41,437 (52.9) | 20,694 (52.9) | |
Age, yr | 62.5±10.6 | 62.4±10.5 | 0.085 |
Duration of diabetes, yr | 5.7±5.9 | 5.8±5.9 | 0.280 |
Receiving CSSA | 5,521 (7.1) | 2,718 (6.9) | 0.493 |
Smoking habit | 0.664 | ||
Never-smoker (includes passive smoker) | 53,117 (67.9) | 26,688 (68.2) | |
Current smoker | 8,379 (10.7) | 4,150 (10.6) | |
Ex-smoker | 12,307 (15.7) | 6,062 (15.5) | |
Missing/Not known | 4,476 (5.7) | 2,239 (5.7) | |
Age, yr | 0.159 | ||
Non-drinker | 53,539 (68.4) | 26,949 (68.9) | |
Current drinker | 2,539 (3.2) | 1,247 (3.2) | |
Social drinker | 12,402 (15.8) | 5,993 (15.3) | |
Ex-drinker | 4,769 (6.1) | 2,439 (6.2) | |
Missing/Not known | 5,030 (6.4) | 2,511 (6.4) | |
Clinical parameters | |||
Diabetes type | 0.510 | ||
Type 1 diabetes mellitus | 86 (0.1) | 43 (0.1) | |
Type 2 diabetes mellitus | 77,789 (99.4) | 38,883 (99.3) | |
Other |
171 (0.2) | 78 (0.2) | |
Missing | 233 (0.3) | 135 (0.3) | |
Diabetic retinopathy status at baseline | 0.006 | ||
R0 | 51,057 (65.2) | 25,844 (66.0) | |
R1 | 27,222 (34.8) | 13,295 (34.0) | |
Body mass index, kg/m2 | 25.9±4.0 | 25.9±4.0 | 0.401 |
Systolic blood pressure, mm Hg | 132.7±15.4 | 132.5±15.4 | 0.022 |
Diastolic blood pressure, mm Hg | 74.8±9.7 | 74.8±9.7 | 0.279 |
HbA1c, % | 7.2±1.3 | 7.2±1.3 | 0.185 |
Total cholesterol, mmol/L | 4.7±0.9 | 4.7±0.9 | 0.243 |
HDL-C, mmol/L | 1.3±0.3 | 1.3±0.3 | 0.790 |
LDL-C, mmol/L | 2.7±0.8 | 2.7±0.8 | 0.197 |
eGFR, mL/min/1.73 m2 | 87.0±21.9 | 87.0±21.9 | 0.921 |
UACR, mg/mmol | 5.6±22.5 | 5.5±22.7 | 0.469 |
Presence of CKD |
17,911 (29.6) | 8,834 (29.1) | 0.091 |
Medication | |||
Oral diabetes drug | 62,325 (79.6) | 31,160 (79.6) | 0.983 |
Insulin | 2,033 (2.6) | 949 (2.4) | 0.077 |
Hypertensive drug | 59,329 (75.8) | 29,690 (75.9) | 0.803 |
Lipid drug | 32,619 (41.7) | 16,327 (41.7) | 0.882 |
History of complication | |||
End-stage renal disease | 93 (0.1) | 51 (0.1) | 0.596 |
Cardiovascular disease | 5,816 (7.4) | 3,010 (7.7) | 0.110 |
Coronary heart disease | 2,593 (3.3) | 1,382 (3.5) | 0.051 |
Heart failure | 322 (0.4) | 160 (0.4) | 0.949 |
Stroke | 3,168 (4.0) | 1,609 (4.1) | 0.601 |
Neuropathy | 130 (0.2) | 78 (0.2) | 0.202 |
Male group |
Female group |
|||
---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |
R0 group | n=18,121 | n=20,503 | ||
Duration of diabetes, yr | 1.03 | 1.02–1.05 | 1.04 | 1.03–1.05 |
HbA1c, % | 1.18 | 1.10–1.26 | 1.27 | 1.19–1.35 |
Systolic blood pressure, mm Hg | ||||
<130 | 1.00 | 1.00 | ||
130–139 | 0.90 | 0.70–1.15 | 1.10 | 0.87–1.40 |
140–149 | 1.03 | 0.78–1.34 | 1.17 | 0.91–1.50 |
150–159 | 0.88 | 0.61–1.27 | 1.20 | 0.88–1.63 |
160 and above | 0.83 | 0.49–1.40 | 1.37 | 0.92–2.03 |
Presence of CKD | ||||
No | 1.00 | 1.00 | ||
Yes | 1.22 | 0.99–1.51 | 1.33 | 1.10–1.61 |
Medication of diabetes | ||||
No diabetes drug | 1.00 | 1.00 | ||
Oral drug only | 1.58 | 1.16–2.14 | 1.21 | 0.93–1.57 |
Insulin | 2.42 | 1.35–4.31 | 2.28 | 1.37–3.79 |
Age, yr | 1.04 | 1.03–1.05 | 1.03 | 1.02–1.04 |
Constant (α) | –8.72 | –8.90 | ||
P value | 0.81 | 0.68 | ||
R1 group | n=10,731 | n=10,873 | ||
Duration of diabetes, yr | 1.03 | 1.02–1.03 | 1.03 | 1.02–1.04 |
HbA1c, % | 1.26 | 1.22–1.29 | 1.36 | 1.32–1.41 |
Systolic blood pressure, mm Hg | ||||
<130 | 1.00 | 1.00 | ||
130–139 | 1.03 | 0.90–1.18 | 1.01 | 0.88–1.16 |
140–149 | 1.21 | 1.05–1.40 | 1.04 | 0.90–1.21 |
150–159 | 1.28 | 1.07–1.52 | 1.19 | 1.00–1.41 |
160 and above | 1.45 | 1.17–1.80 | 1.26 | 1.02–1.56 |
Presence of CKD | ||||
No | 1.00 | 1.00 | ||
Yes | 1.39 | 1.25–1.55 | 1.26 | 1.13–1.41 |
Medication of diabetes | ||||
No diabetes drug | 1.00 | 1.00 | ||
Oral drug only | 1.84 | 1.48–2.29 | 1.83 | 1.46–2.28 |
Insulin | 2.33 | 1.74–3.12 | 1.95 | 1.43–2.66 |
Age, yr | 1.01 | 1.00–1.01 | 1.02 | 1.01–1.02 |
Constant (α) | –5.56 | –6.80 | ||
P value | 0.52 | 0.50 |
Variable | Male group (n=11,360) | Female group (n=12,320) |
---|---|---|
Predicted events (%) | 636 (5.6) | 592 (4.8) |
Observed events (%) | 582 (5.1) | 564 (4.6) |
Hosmer-Lemeshow test, P value | 0.724 | 0.099 |
AUC (95% CI) | 0.80 (0.78–0.81) | 0.81 (0.79–0.83) |
Variable | 2.5% Risk margin |
2.5% for R0 and 5.0% risk margin for R1 |
||||
---|---|---|---|---|---|---|
R0 (n=14,932) | R1 (n=8,748) | Overall (n=23,680) | R0 (n=14,932) | R1 (n=8,748) | Overall (n=23,680) | |
Assigned screening interval based on predicted time to risk margin, % | ||||||
6-month interval | 2.4 | 95.0 | 36.6 | 2.4 | 68.2 | 26.7 |
12-month interval | 11.0 | 4.4 | 8.5 | 11.0 | 20.3 | 14.5 |
24-month interval | 86.6 | 0.6 | 54.8 | 86.6 | 11.5 | 58.8 |
Total screening visits over a 2-year period | ||||||
Annual screening | 29,864 | 17,496 | 47,360 | 29,864 | 17,496 | 47,360 |
Tailored screening (our model) | 17,650 | 34,065 | 51,715 | 17,650 | 28,422 | 46,072 |
Difference in the screening visits (compare to annual screen) | –12,214 | 16,569 | 4,355 | –12,214 | 10,926 | –1,288 |
Relative difference from annual screening, % | –40.9 | 94.7 | 9.2 | –40.9 | 62.4 | –2.7 |
Values are presented as number (%) or mean±standard deviation. RAMP-DM, The Risk Assessment and Management Programme–Diabetes Mellitus; CSSA, comprehensive social security assistance; R0, no diabetic retinopathy; R1, background diabetic retinopathy in at least one eye; HbA1c, glycosylated hemoglobin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; UACR, urine albumin-to-creatinine ratio; CKD, chronic kidney disease. Other: gestational or unclassified; Classification of CKD: eGFR <60 mL/min/1.73 m2 or UACR ≥3 mg/mmol from Kidney Disease Improving Global Outcomes 2012 guideline.
HR, hazard ratio; CI, confidence interval; R0, no diabetic retinopathy; HbA1c, glycosylated hemoglobin; CKD, chronic kidney disease; R1, background diabetic retinopathy in at least one eye.
Values are presented as number (%). Results from Hosmer-Lemeshow test for calibration and AUC with 95% CI for discrimination. AUC, area under the receiver operative characteristic curve; CI, confidence interval.
R0, no diabetic retinopathy; R1, background diabetic retinopathy in at least one eye.