A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: A cross-sectional study based on a large community survey in China.

Mingyue Xue,Li Liu,Hua Yao,Yinxia Su,Shuxia Wang,Kun Lv,Mingchen Zhang,Sabine Rohrmann

doi:10.1371/journal.pone.0236957

Abstract

ObjectivesCompared with unaffected individuals, patients with type 2 diabetes (T2DM) have higher risk of hypertension, and diabetes combined with hypertension can lead to server cardiovascular disease. Therefore, the purpose of this study was to establish a simple nomogram model to identify the determinants of hypertension in patients with T2DM and to quickly calculate the probability of hypertension in individuals with T2DM.Materials and methodsA total of 643,439 subjects participating in the national physical examination has been recruited in this cross-sectional study. After excluding unqualified subjects, 30,507 adults with T2DM were included in the final analysis. 21,355 and 9,152 subjects were randomly assigned to the model developing group and validation group, respectively, with a ratio of 7:3. The potential risk factors used in this study to assess hypertension in patients with T2DM included questionnaire investigation and physical measurement variables. We used the least absolute shrinkage and selection operator models to optimize feature selection, and the multivariable logistic regression analysis was for predicting model. Discrimination and calibration were assessed using the receiver operating curve (ROC) and calibration curve.ResultsThe results showed that the major determinants of hypertension in patients with T2DM were age, gender, drinking, exercise, smoking, obesity and atherosclerotic vascular disease. The area under ROC curve of developing group and validation group are both 0.814, indicating that the prediction model owns high disease recognition ability. The p values of the two calibration curves are 0.625 and 0.445, suggesting that the nomogram gives good calibration.ConclusionThe individualized nomogram model can facilitate improved screening and early identification of patients with hypertension in T2DM. This procedure will be useful in developing regions with high epidemiological risk and poor socioeconomic status just like Urumqi, in Northern China.

Highlights

Diabetes, cancer and cerebrovascular and cardiovascular diseases (CCVd) are known as the major chronic diseases in the world, which threatening human life and people’s physical and mental health with the rising trend
The results showed that the major determinants of hypertension in patients with Type 2 diabetes mellitus (T2DM) were age, gender, drinking, exercise, smoking, obesity and atherosclerotic vascular disease
A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension

Summary

Introduction

Cancer and cerebrovascular and cardiovascular diseases (CCVd) are known as the major chronic diseases in the world, which threatening human life and people’s physical and mental health with the rising trend. Blood glucose and blood pressure control are the priority of national public health in China [1]. The prevalence of hypertension should be paid more attention as well, a nationwide survey shows that 29.6%(about 311.9 million) of Chinese adults over 18 years old have high blood pressure, and 41.3%(about 244.5 million) are in pre-hypertension (pre-HTN) [3], while the treatment and control rate in all hypertensives are less than 30% and 10%, respectively [4]. A national survey of outpatients and community residents in China shows that nearly a quarter of diabetic patients have hypertension at the same time, but the control rate of blood pressure is low [4, 7, 8]. The early detection and economical screening for hypertension in diabetic patients will be a more urgent challenge for doctors all over the world

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