Evidence mapPaperPMID 39578908Full record

ArticleDiabetology & metabolic syndrome2024

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model.

Zhenkun Yang, Yuanjie Li, Yang Liu, Ziyi Zhong, Coleen Ditchfield, Taipu Guo, Mingjuan Yang, Yang Chen

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Article in Diabetology & metabolic syndrome, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

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7citing papers in PubMed
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3 · Its place in the literature

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7 citing papers in PubMed.

  1. Article
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  3. Nonlinear relationship between mean amplitude of glycemic excursion and mortality in critically ill stroke patients.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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5 · Who and what money

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8 authors.

Zhenkun Yang *Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.
Yuanjie Li *Tianjin Research Institute of Anesthesiology, Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
Yang LiuDepartment of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China.
Ziyi ZhongDepartment of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Coleen DitchfieldDepartment of Medicine for Older People, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.
Taipu GuoTianjin Research Institute of Anesthesiology, Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
Mingjuan YangDepartment of Cardiology, Tianjin Medical University General Hospital, Tianjin, China.
Yang ChenLiverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK. yang.chen2@liverpool.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.

methodsPatients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008-2019) as primary analysis cohort and admissions (2020-2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.

results2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0-79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0-81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09-1.93; T3: HR 1.96, 95%CI 1.48-2.60), 1-year (T2: HR 1.25, 95%CI 1.02-1.53; T3: HR 1.54, 95%CI 1.26-1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10-1.56; T3: HR 1.48, 95%CI 1.23-1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.

conclusionGV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.

Indexed as

Glycaemic variabilityHeart failure with preserved ejection fractionMachine learningMortalityType 2 diabetes mellitus

Identifiers

PMID39578908
PMCPMC11585110

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.