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- Title
Validation of a nomogram for predicting regression from impaired fasting glucose to normoglycaemia to facilitate clinical decision making.
- Authors
Guo, Vivian Y. W.; Yu, Esther Y. T.; Wong, Carlos K. H.; Sit, Regina W. S.; Wang, Jenny H. L.; Ho, S. Y.; Lam, Cindy L. K.; Guo, Vivian Yw; Yu, Esther Yt; Wong, Carlos Kh; Sit, Regina Ws; Wang, Jenny Hl; Lam, Cindy Lk
- Abstract
<bold>Background: </bold>In Hong Kong, fasting plasma glucose (FPG) is the most popular screening test for diabetes mellitus (DM) in primary care. Individuals with impaired fasting glucose (IFG) are commonly encountered.<bold>Objectives: </bold>To explore the determinants of regression to normoglycaemia among primary care patients with IFG based on non-invasive variables and to establish a nomogram for the prediction of regression from IFG.<bold>Methods: </bold>This cohort study consisted of 1197 primary care patients with IFG. These subjects were invited to repeat a FPG test and 75-g 2-hour oral glucose tolerance test (2h-OGTT) to determine the glycaemia change. Normoglycaemia was defined as FPG <5.6 mmol/L and 2h-OGTT <7.8 mmol/L. Stepwise logistic regression model was developed to predict the regression to normoglycaemia with non-invasive variables, using a randomly selected training dataset (810 subjects). The model was validated on the remaining testing dataset (387 subjects). Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test were used to evaluate discrimination and calibration of the model. A nomogram was constructed based on the model.<bold>Results: </bold>After a mean follow-up period of 6.1 months, 180 subjects (15.0%) had normoglycaemia based on the repeated FPG and 2h-OGTT results at follow-up. Subjects without central obesity or hypertension, with moderate-to-high-level physical activity and a lower baseline FPG level, were more likely to regress to normoglycaemia. The prediction model had acceptable discrimination (AUC = 0.705) and calibration (P = 0.840).<bold>Conclusion: </bold>The simple-to-use nomogram could facilitate identification of subjects with low risk of progression to DM and thus aid in clinical decision making and resource prioritization in the primary care setting.
- Subjects
HONG Kong (China); NOMOGRAPHY (Mathematics); FASTING; DECISION making; DIABETES; COHORT analysis; LOGISTIC regression analysis; BLOOD sugar analysis; DIAGNOSIS of diabetes; GLUCOSE intolerance; COMPARATIVE studies; GLUCOSE tolerance tests; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PRIMARY health care; RESEARCH; EVALUATION research; RECEIVER operating characteristic curves; STATISTICAL models; DIAGNOSIS
- Publication
Family Practice, 2016, Vol 33, Issue 4, p401
- ISSN
0263-2136
- Publication type
journal article
- DOI
10.1093/fampra/cmw031