Diagnosis and predictive clinical and para-clinical cutoffs for diabetes complications in Lur and Lak populations of Iran; a ROC curve analysis to design a regional guideline

Abstract

Introduction: American Diabetes Association updates its guideline every year. However this guideline can be changed for different populations based on their cultural and genetic status. Objectives: We intend to design a regional study in Lur and Lak populations of Iran using receiver operating characteristics (ROC) curve model. Patients and Methods: A total of 133 diabetes mellitus (DM) patients were enrolled in this study. The collected information for each patient were gender, age, body mass index (BMI), DM type, DM duration, fasting blood sugar (FBS), hemoglobin A1c (HbA1c), lipid profile, type of treatments, type of statin and dose, documented neuropathy, documented nephropathy, symptomatic retinopathy, peripheral vessel disease (PVD), documented cardiovascular disease (CVD), food ulcer history, dawn effect, systolic blood pressure (SBP), and diastolic blood pressure (DBP). ROC curve was used and area under curve (AUC) was reported. Results: For neuropathy, age was the most accurate diagnostic index (area under curve [AUC] = 79%). For nephropathy SBP was the most accurate diagnostic index (AUC= 88%). For symptomatic retinopathy DM duration was the most accurate diagnostic index (AUC= 81%). For PVD, HDL-C was the most accurate diagnostic index (reverse AUC= 67%). For CVD age was the most accurate diagnostic index (AUC= 81%). For foot ulcer history age was the most accurate diagnostic index (AUC= 85%). Conclusion: The final suggested guideline is like the international guidelines. However some unique points should be regarded. Blood pressure >165/110 mm Hg is diagnostic of diabetic nephropathy. Additionally serum high-density lipoprotein (HDL-C) >48 mg/dL is strongly suggested.