Background: Type 2 diabetes mellitus (T2DM) is highly prevalent worldwide and may lead to a higher rate of cognitive dysfunction. This study aimed to develop and validate a nomogram-based model to detect mild cognitive impairment (MCI) in T2DM patients.
Methods: Inpatients with T2DM in the endocrinology department of Xiangya Hospital were consecutively enrolled between March and December 2021. Well-qualified investigators conducted face-to-face interviews with participants to retrospectively collect sociodemographic characteristics, lifestyle factors, T2DM-related information, and history of depression and anxiety. Cognitive function was assessed using the Mini-Mental State Examination scale. A nomogram was developed to detect MCI based on the results of the multivariable logistic regression analysis. Calibration, discrimination, and clinical utility of the nomogram were subsequently evaluated by calibration plot, receiver operating characteristic curve, and decision curve analysis, respectively.
Results: A total of 496 patients were included in this study. The prevalence of MCI in T2DM patients was 34.1% (95% confidence interval [CI]: 29.9%-38.3%). Age, marital status, household income, diabetes duration, diabetic retinopathy, anxiety, and depression were independently associated with MCI. Nomogram based on these factors had an area under the curve of 0.849 (95% CI: 0.815-0.883), and the threshold probability ranged from 35.0% to 85.0%.
Conclusions: Almost one in three T2DM patients suffered from MCI. The nomogram, based on age, marital status, household income, duration of diabetes, diabetic retinopathy, anxiety, and depression, achieved an optimal diagnosis of MCI. Therefore, it could provide a clinical basis for detecting MCI in T2DM patients.
背景:2型糖尿病(T2DM)在世界范围内非常普遍, 可导致较高的认知功能障碍发生率。本研究的目的是建立并验证基于列线图的T2DM患者轻度认知功能障碍(MCI)筛查模型。 方法:连续纳入2021年3至12月在湘雅医院内分泌科住院的T2DM患者。研究人员对患者进行面对面访谈, 回顾性收集社会人口学特征、生活方式因素、T2DM相关信息以及抑郁和焦虑病史。采用简易精神状态检查量表评估认知功能。根据多因素logistic回归分析结果建立预测MCI的列线图模型。通过校准图、受试者工作特征曲线和决策曲线分析评估列线图的校准度、区分度和临床效用。 结果:本研究共纳入496例患者。T2DM患者的MCI患病率为34.1%(95%可信区间:29.9% ~ 38.3%)。年龄、婚姻状况、家庭收入、糖尿病病程、糖尿病视网膜病变、焦虑和抑郁与MCI独立相关。基于这些因素构建的列线图曲线下面积为0.849 (95% CI: 0.815 ~ 0.883), 阈值概率范围为35.0% ~ 85.0%。 结论:近1/3的T2DM患者存在MCI。基于年龄、婚姻状况、家庭收入、糖尿病病程、糖尿病视网膜病变、焦虑和抑郁的列线图诊断MCI最佳。列线图可为T2DM患者MCI的检测提供临床依据。.
Keywords: 2型糖尿病; diagnosis; mild cognitive impairment; model; nomogram; type 2 diabetes mellitus; 列线图; 模型; 诊断; 轻度认知障碍.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.