Abstract
BackgroundMany prognostic models of diabetic microvascular complications have been developed, but their performances still varies. Therefore, we conducted a systematic review and meta-analysis to summarise the performances of the existing models.MethodsPrognostic models of diabetic microvascular complications were retrieved from PubMed and Scopus up to 31 December 2020. Studies were selected, if they developed or internally/externally validated models of any microvascular complication in type 2 diabetes (T2D).ResultsIn total, 71 studies were eligible, of which 32, 30 and 18 studies initially developed prognostic model for diabetic retinopathy (DR), chronic kidney disease (CKD) and end stage renal disease (ESRD) with the number of derived equations of 84, 96 and 51, respectively. Most models were derived-phases, some were internal and external validations. Common predictors were age, sex, HbA1c, diabetic duration, SBP and BMI. Traditional statistical models (i.e. Cox and logit regression) were mostly applied, otherwise machine learning. In cohorts, the discriminative performance in derived-logit was pooled with C statistics of 0.82 (0.73‑0.92) for DR and 0.78 (0.74‑0.83) for CKD. Pooled Cox regression yielded 0.75 (0.74‑0.77), 0.78 (0.74‑0.82) and 0.87 (0.84‑0.89) for DR, CKD and ESRD, respectively. External validation performances were sufficiently pooled with 0.81 (0.78‑0.83), 0.75 (0.67‑0.84) and 0.87 (0.85‑0.88) for DR, CKD and ESRD, respectively.ConclusionsSeveral prognostic models were developed, but less were externally validated. A few studies derived the models by using appropriate methods and were satisfactory reported. More external validations and impact analyses are required before applying these models in clinical practice.Systematic review registrationPROSPERO CRD42018105287
Highlights
Many prognostic models of diabetic microvascular complications have been developed, but their performances still varies
Study selection Studies, published in any language, were eligible if they studied in adult Type 2 diabetes (T2D), developed or validated any multivariable prognostic models of microvascular complications in T2D with applying any traditional statistical modelling or machine learning (ML), and reported model performance
A total of 32/1009 and 44/3321 studies were eligible for diabetic retinopathy (DR) and diabetic nephropathy (DN), respectively, see Table S1
Summary
Many prognostic models of diabetic microvascular complications have been developed, but their performances still varies. Type 2 diabetes (T2D) has increased rapidly over the past 30 years becoming worldwide public health problem with prevalence in adults of 463 million (9.3%) in 2019. Saputro et al Syst Rev (2021) 10:288 disability, impaired quality of life and leading cause of premature death, which accounted for 11.3% of the global mortality [1, 3]. DR is the major cause of blindness [6] through fractional retinal detachment, preretinal or vitreous haemorrhage and central vision impairment, with the prevalence of 25% globally [7]
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