Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy.
Biological and Environmental Sciences and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
Front Endocrinol (Lausanne). 2024 Apr 30;15:1359482. doi: 10.3389/fendo.2024.1359482. eCollection 2024.
Prognostic risk stratification in older adults with type 2 diabetes (T2D) is important for guiding decisions concerning advance care planning.
A retrospective longitudinal study was conducted in a real-world sample of older diabetic patients afferent to the outpatient facilities of the Diabetology Unit of the IRCCS INRCA Hospital of Ancona (Italy). A total of 1,001 T2D patients aged more than 70 years were consecutively evaluated by a multidimensional geriatric assessment, including physical performance evaluated using the Short Physical Performance Battery (SPPB). The mortality was assessed during a 5-year follow-up. We used the automatic machine-learning (AutoML) JADBio platform to identify parsimonious mathematical models for risk stratification.
Of 977 subjects included in the T2D cohort, the mean age was 76.5 (SD: 4.5) years and 454 (46.5%) were men. The mean follow-up time was 53.3 (SD:15.8) months, and 209 (21.4%) patients died by the end of the follow-up. The JADBio AutoML final model included age, sex, SPPB, chronic kidney disease, myocardial ischemia, peripheral artery disease, neuropathy, and myocardial infarction. The bootstrap-corrected concordance index (c-index) for the final model was 0.726 (95% CI: 0.687-0.763) with SPPB ranked as the most important predictor. Based on the penalized Cox regression model, the risk of death per unit of time for a subject with an SPPB score lower than five points was 3.35 times that for a subject with a score higher than eight points (P-value <0.001).
Assessment of physical performance needs to be implemented in clinical practice for risk stratification of T2D older patients.
在患有 2 型糖尿病（T2D）的老年人中进行预后风险分层对于指导有关预先护理计划的决策很重要。
对来自意大利安科纳 IRCCS INRCA 医院糖尿病科门诊的老年糖尿病患者的真实世界样本进行了回顾性纵向研究。共有 1001 名年龄超过 70 岁的 T2D 患者接受了多维老年评估，包括使用短体力量表（SPPB）评估的身体表现。在 5 年的随访期间评估死亡率。我们使用自动机器学习（AutoML）JADBio 平台来识别用于风险分层的简约数学模型。
在 T2D 队列中，有 977 名受试者被纳入，平均年龄为 76.5（SD：4.5）岁，其中 454 名（46.5%）为男性。平均随访时间为 53.3（SD：15.8）个月，随访结束时 209 名（21.4%）患者死亡。JADBio AutoML 最终模型包括年龄、性别、SPPB、慢性肾脏病、心肌缺血、外周动脉疾病、神经病和心肌梗死。最终模型的bootstrap 校正一致性指数（c-index）为 0.726（95%CI：0.687-0.763），SPPB 排名最高。基于惩罚 Cox 回归模型，SPPB 评分低于 5 分的受试者每单位时间死亡的风险是 SPPB 评分高于 8 分的受试者的 3.35 倍（P 值<0.001）。
对于 T2D 老年患者的风险分层，需要在临床实践中实施身体表现评估。
