Evidence mapPaperPMID 42100202Full record

ArticleFrontiers in endocrinology2026

Development and validation of a multi-center nomogram for the presence of diabetic retinopathy in patients with type 2 diabetes: incorporating homocysteine, glycemic, lipid, and renal markers.

Liming Wu, Risu Na, Ling Qiu

Abstract readMulticenter StudyValidation Study
In one paragraph

Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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3 authors.

Liming WuDepartment of Endocrinology, Shanghai Fengxian District Central Hospital, Shanghai, China.
Risu NaDepartment of Endocrinology, Shanghai Xuhui District Central Hospital, Shanghai, China.
Ling QiuDepartment of Endocrinology, Shanghai Xuhui District Central Hospital, Shanghai, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: To develop and validate a nomogram that integrates plasma homocysteine with glycemic, lipid, and renal markers for estimating the probability of prevalent diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: This multi-center retrospective study included 930 patients. A development cohort (n=651; 145 DR events, 22.3% prevalence) was recruited from Shanghai Fengxian District Central Hospital, and an independent validation cohort (n=279; 71 DR events, 25.4% prevalence) was recruited from Shanghai Xuhui District Central Hospital. The primary outcome was the presence of DR based on fundus examination. Candidate clinical variables included demographic, clinical, and laboratory data. After pre-screening for multicollinearity, Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select informative indicators. A multivariable logistic regression model was built, and a nomogram was constructed. Model performance was evaluated by discrimination (area under the curve, AUC), calibration (Brier score, calibration-in-the-large [CITL]), and clinical utility (Decision Curve Analysis, DCA). Results: Eight variables were selected for the final model: Age, T2DM Duration, Systolic Blood Pressure, HbA1c, HDL-C, estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), and Homocysteine. The nomogram demonstrated favorable discrimination with an AUC of 0.865 in the development cohort and maintained a stable performance with an AUC of 0.842 in the validation cohort. Calibration was adequate in both sets (development Brier score 0.132, CITL 0.02; validation Brier score 0.148, CITL 0.15). DCA showed a positive net benefit for clinical decision-making across a wide range of threshold probabilities (10% to 75%). Subgroup analyses confirmed consistent performance across different patient demographics. Conclusion: A nomogram combining homocysteine with traditional clinical and renal markers shows promising capability in assessing the probability of prevalent DR in T2DM patients. While demonstrating potential applicability for screening prioritization, these retrospective findings require further prospective validation before the tool can be routinely implemented to guide clinical management.

Indexed as

BiomarkersBlood GlucoseDiabetes Mellitus, Type 2Diabetic RetinopathyHomocysteineLipidsNomogramsAgedChinaFemaleHumansMaleMiddle AgedRetrospective StudiesBiomarkersBlood GlucoseHomocysteineLipidsdiabetic retinopathyhomocysteinenomogramrisk assessment tooltype 2 diabetes mellitus

Identifiers

PMID42100202
PMCPMC13143537

What Socratic holds

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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.