SYmptom-Based STratification of DiabEtes Mellitus by Renal Function Decline (SYSTEM): A Retrospective Cohort Study and Modeling Assessment
| العنوان: | SYmptom-Based STratification of DiabEtes Mellitus by Renal Function Decline (SYSTEM): A Retrospective Cohort Study and Modeling Assessment |
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| المؤلفون: | Kam Yan Yu, Tak Yee Chow, Sydney C.W. Tang, Nevin L. Zhang, Vivian Taam Wong, Yulong Xu, Saimei Li, Kam Wa Chan |
| المصدر: | Frontiers in Medicine, Vol 8 (2021) Frontiers in Medicine |
| بيانات النشر: | Frontiers Media S.A., 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | 0301 basic medicine, Research design, integrative medicine, medicine.medical_specialty, Medicine (General), renal medicine, diagnosis, Population, Renal function, 03 medical and health sciences, 0302 clinical medicine, Bloating, R5-920, Internal medicine, Diabetes mellitus, Epidemiology, medicine, Outpatient clinic, 030212 general & internal medicine, education, Original Research, education.field_of_study, diabetes, business.industry, Retrospective cohort study, General Medicine, medicine.disease, symptom, diabetic kidney disease, 030104 developmental biology, traditional chinese medicine, Medicine, epidemiology, business |
| الوصف: | Background: Previous UK Biobank studies showed that symptoms and physical measurements had excellent prediction on long-term clinical outcomes in general population. Symptoms and signs could intuitively and non-invasively predict and monitor disease progression, especially for telemedicine, but related research is limited in diabetes and renal medicine.Methods: This retrospective cohort study aimed to evaluate the predictive power of a symptom-based stratification framework and individual symptoms for diabetes. Three hundred two adult diabetic patients were consecutively sampled from outpatient clinics in Hong Kong for prospective symptom assessment. Demographics and longitudinal measures of biochemical parameters were retrospectively extracted from linked medical records. The association between estimated glomerular filtration rate (GFR) (independent variable) and biochemistry, epidemiological factors, and individual symptoms was assessed by mixed regression analyses. A symptom-based stratification framework of diabetes using symptom clusters was formulated by Delphi consensus method. Akaike information criterion (AIC) and Bayesian information criterion (BIC) were compared between statistical models with different combinations of biochemical, epidemiological, and symptom variables.Results: In the 4.2-year follow-up period, baseline presentation of edema (−1.8 ml/min/1.73m2, 95%CI: −2.5 to −1.2, p < 0.001), epigastric bloating (−0.8 ml/min/1.73m2, 95%CI: −1.4 to −0.2, p = 0.014) and alternating dry and loose stool (−1.1 ml/min/1.73m2, 95%CI: −1.9 to −0.4, p = 0.004) were independently associated with faster annual GFR decline. Eleven symptom clusters were identified from literature, stratifying diabetes predominantly by gastrointestinal phenotypes. Using symptom clusters synchronized by Delphi consensus as the independent variable in statistical models reduced complexity and improved explanatory power when compared to using individual symptoms. Symptom-biologic-epidemiologic combined model had the lowest AIC (4,478 vs. 5,824 vs. 4,966 vs. 7,926) and BIC (4,597 vs. 5,870 vs. 5,065 vs. 8,026) compared to the symptom, symptom-epidemiologic and biologic-epidemiologic models, respectively. Patients co-presenting with a constellation of fatigue, malaise, dry mouth, and dry throat were independently associated with faster annual GFR decline (−1.1 ml/min/1.73m2, 95%CI: −1.9 to −0.2, p = 0.011).Conclusions: Add-on symptom-based diagnosis improves the predictive power on renal function decline among diabetic patients based on key biochemical and epidemiological factors. Dynamic change of symptoms should be considered in clinical practice and research design. |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c8a5706535fc73b38bcc7458e5aa1dd5 https://www.frontiersin.org/articles/10.3389/fmed.2021.682090/full |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....c8a5706535fc73b38bcc7458e5aa1dd5 |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |