Predictive model of macrovascular complications at the time of diagnosis of patients with type 2 diabetes
Keywords:
diabetes mellitus type 2, heart disease risk factors, high blood pressure.Abstract
Introduction: Cardiovascular disease is the main cause of mortality in people with type 2 diabetes mellitus.
Objective: Design a predictive model of macrovascular complications in patients with type 2 diabetes at the time of diagnosis.
Methods: An observational, of cases and controls, retrospective study was carried out. The population studied were all patients diagnosed with type 2 diabetes mellitus in the "José Martí" health area of the province of Santiago de Cuba, during the period from September 2018 to December 2022. 40 cases with macrovascular complications and 80 controls were studied. randomly selected from the same population, without complications. To build the model, binary logistic regression was applied and those that were associated with macrovascular complications in a previous bivariate analysis were used as independent variables.
Results: The variables that were included in the model, after the binary logistic regression analysis, were arterial stiffness, hyperlipidaemia, and arterial hypertension. Hosmer-Lemeshow test= 6.027; p= 0.644. The sensitivity of 77.50 % and specificity of 90.00 %; with a positive predictive value of 79.49 and negative predictive value of 88.89; and validity index equal to 85.83. The observed area under the Receiver Operating Characteristic curve is 0.933, with a significance associated with the calculated statistic of 0.000.
Conclusions: The designed model is a good predictor of macrovascular complications in patients with type 2 diabetes at the time of diagnosis.
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References
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21. Kim HL, Lim WH, Seo JB, Kim SH, Zo ZH, Kim MA. Prediction of cardiovascular events using brachial-ankle pulse wave velocity in hypertensive patients [Internet]. Journal of Clinical Hypertension (Greenwich, Conn.). 2020; 22(9):1659-65. DOI: 10.1111/jch.13992
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23. Mehta Roopa, Antonio Villa NE, Bello Chavolla OY, Martagón Alexandro J, Elias López D, Vargas Vázquez A, et al. La asociación entre la resistencia a la insulina y la rigidez arterial en pacientes mexicanos sin diabetes mellitus tipo 2 [Internet]. Gac Méd Méx. 2021 [acceso: 01/05/2024]; 157(5):539-47. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016381320210-00500539&lng=es
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25. Revueltas Agüero M, Molina Esquivel E. La diabetes mellitus como factor de riesgo cardiovascular [Internet]. AMC. 2022 [acceso: 06/04/2024]; 26:e8715. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S10250255202200010-0050&lng=es
26. Yang DR, Wang MY, Zhang CL, Wang Y. Endothelial dysfunction in vascular complications of diabetes: a comprehensive review of mechanisms and implications [Internet]. Front Endocrinol (Lausanne). 2024; 15:1359255. DOI: 10.3389/fendo.2024.1359255
27. Muthanna BAB, Sadangi RKM, Hosur BLC, Jain NKC, Monga IS. Sonographic Evaluation of Carotid Intima-Media Thickness and Carotid Plaques in Coronary Artery Disease Patients [Internet]. Journal of Marine Medical Society. 2023; 25(Suppl 1):S58-S63. DOI: 10.4103/jmms.jmms_71_22
28. Cruz Y, Camejo N, Cruz Y, Zúñiga E, Cruz G, Palomo Z. Ecografía Doppler carotídea en pacientes con enfermedad cerebrovascular isquémica [Internet]. Correo Científico Médico. 2021 [acceso: 15/07/2023]; 25(4):19. Disponible en: https://revcocmed.sld.cu/index.php/cocmed/article/view/4031/1994
29. Castro D, Brito NJ, Saab T, García N. Hallazgos del sistema carotídeo mediante ultrasonografía tríplex en pacientes con ictus isquémico [Internet]. Rev Biomed. 2020; 31(3):125-33. DOI: 10.32776/revbiomed.v31i3.819
30. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile. A statement por Health professionals [Internet]. Circulation. 1991; 83:356-62. DOI: 10.1161/01.cir.83.1.356
31. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, de Bac-ker G, et al. SCORE project group. Estimation of ten-year riskof fatal cardiovascular disease in Europe: The SCORE Project [Internet]. Eur Heart J. 2003; 24:987-1003. DOI: 10.1016/s0195-668x(03)00114-3
32. Stevens RJ, Kothari V, Adler AI, Straton IM, Holman RR. United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKDPS risk engine: A model for the risk of coronary heart disease in Type II diabetes (UKPDS 56) [Internet]. Clin Sci (Lon). 2001 [acceso: 06/04/2024]; 101:617-9. DOI: 10.1042/cs1010671
33. Kengne AP, Patel A, Marre M, Travert F, Lievre M, Zoungas S, et al. Contemporary model for cardiovascular risk prediction in people with type 2 diabetes [Internet]. European Journal of Cardiovascular Prevention & Rehabilitation. 2011; 18(3):393-8. DOI: 10.1177/1741826710394270
2. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045 [Internet]. Diabetes Research and Clinical Practice. 2022; 183:109119. DOI: 10.1016/j.diabres.2021.109119
3. Oficina Nacional de Estadística e Información. Anuario Estadístico de Cuba [Internet]. La Habana: ONEI; 2023. [acceso: 20/11/2023]. Disponible en: https://www.onei.gob.cu/sites/default/files/publicaciones/2023-08/19_salud_publica-_asistencia-social-2022-edicion-2023
4. Organización Panamericana de la Salud. Diagnóstico y manejo de la diabetes de tipo 2 (HEARTSD) [Internet]. Washington, D.C: OPS, OMS; 2020. . [acceso: 13/11/2021] . Disponible en: https://iris.paho.org/bitstream/handle/10665.2/53007/OPSWNMHNV200043_-spa.pdf?sequence= 1&isAllowed=y
5. Kolaric V, Svircevic V, Bijuk R, Zupancic V. Chronic complications of diabetes and quality of life [Internet]. Acta Clinica Croatica. 2022; 61(3):520-7. DOI: 10.20471/acc.2022.61.03.18
6. Sánchez-Delgado J, Sánchez-Lara N. Epidemiología de la diabetes mellitus tipo 2 y sus complicaciones [Internet]. Revista Finlay. 2022 [acceso: 06/04/2024]; 12(2):[aprox. 8 p.]. Disponible en: https://revfinlay.sld.cu/index.php/finlay/article/view/1121
7. Aikaeli F, Njim T, Gissing S, Moyo F, Alam U, Mfinanga SG, et al. Prevalence of microvascular and macrovascular complications of diabetes in newly diagnosed type 2 diabetes in low-and-middle-income countries: A systematic review and meta-analysis [Internet]. Rev PLOS Glob Public Health. 2022; 2(6):e0000599. DOI: 10.1371/journal.pgph.0000599
8. Song DK, Hong YS, Sung YA, Lee H. Risk factor control and cardiovascular events in patients with type 2 diabetes mellitus [Internet]. PLoS One. 2024; 19(2):e0299035. DOI: 10.1371/journal.pone.0299035
9. Valle T, Gato CA, Rodríguez M, Hernández JR, Rosales G, Lago Y. Cardiovascular risk in patients admitted to a Diabetic Care Center [Internet]. Arch méd Camagüey. 2023 [acceso: 06/04/2024]; 27:e9479. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S10250255202300010-0036&lng=es
10. Yam AV, Chimal CI, Chávez AA, Candila JA, Medina J. Riesgo cardiovascular en adultos con diabetes tipo 2 de un centro de Atención Primaria en México [Internet]. Revista Iberoamericana de Enfermería Comunitaria: RIdEC. 2023 [acceso: 09/08/2023]; 16(1):39-46. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=9111538
11. Damaskos C, Garmpis N, Kollia P, Mitsiopoulos G, Barlampa D, Drosos A, et al. Assessing Cardiovascular Risk in Patients with Diabetes: An Update [Internet]. Curr Cardiol Rev. 2020; 16(4):266-74. DOI: 10.2174/1573403X1566619111112362
12. Gómez M, Patino MC, Gómez L, Recio JI, Rodríguez E, Maderuelo JA, et al. Valores de referencia de parámetros de rigidez arterial y su relación con los factores de riesgo cardiovascular en población española [Internet]. Rev Esp Cardiol. 2020 [acceso: 06/04/2024]; 73(1):43-52. Disponible en : https://pesquisa.bvsalud.org/portal/resource/pt/ibc-194087
13. Yasuharu T, Setoh K, Kawaguchi T, Nakayama T, Matsuda F, Nagahama study group. Brachial-ankle pulse wave velocity and cardio-ankle vascular index are associated with future cardiovascular events in a general population: The Nagahama Study [Internet]. J Clin Hypertens (Greenwich). 2021; 23(7):1390-8. DOI: 10.1111/jch.14294
14. Nicolaides A, Panayiotou A, Griffin M, Tyllis T, Bond D, Georgiou N, et al. Pruebas de ultrasonido arterial para predecir eventos cardiovasculares ateroscleróticos [Internet]. J Am Coll Cardiol. 2022; 79(20):1969-82. DOI: 10.1016/j.jacc.2022.03.352
15. Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, et al. Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clinical practice statement [Internet]. Am J Prev Cardiol. 2022; 10:100335. DOI: 10.1016/j.ajpc.2022.100335
16. Rojas NH, del Rio Caballero G, Magdariaga AH, Ruiz RB, de Cuba AMS, Duany JC, et al. Factores de riesgo tradicionales predictivos de mortalidad por enfermedad cardiovascular en el adulto mayor [Internet]. Rev. cuba. cardiol. cir. cardiovasc. 2023 [acceso: 21/01/2023]; 29(3):2189. Disponible en: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/2189/pdf
17. American Diabetes Association Professional Practice Committee; 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022 [Internet]. Diabetes Care. 2022 [acceso: 06/04/2024]; 45(Supplement_1):S17-S38. DOI: 10.2337/dc22-S002
18. Colectivo de autores. Programa nacional de diabetes [Internet]. La Habana: Editorial Ciencias Médicas; 2003. . [acceso: 21/01/2023]. Disponible en: https://extranet.who.int/ncdccs/Data/CUB_B6_Programa%20Nacional%20-de%20Diabetes%20Cuba..pdf
19. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects [Internet]. JAMA. 2013 [acceso: 29/10/2022]; 310(20):2191-4. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/1760318
20. Wu Z, Yu S, Zhang H, Guo Z, Zheng Y, Xu Z, et al. Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes [Internet]. Cardiovascular Diabetology. 2022; 21(1):262. DOI: 10.1186/s12933-022-01696-1
21. Kim HL, Lim WH, Seo JB, Kim SH, Zo ZH, Kim MA. Prediction of cardiovascular events using brachial-ankle pulse wave velocity in hypertensive patients [Internet]. Journal of Clinical Hypertension (Greenwich, Conn.). 2020; 22(9):1659-65. DOI: 10.1111/jch.13992
22. Tian X, Zuo Y, Chen S, Zhang Y, Zhang X, Xu Q, et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study [Internet]. Hypertension. 2022; 79(7):1487-96. DOI: 10.1161/HYPERTENSIONAHA.122.19256
23. Mehta Roopa, Antonio Villa NE, Bello Chavolla OY, Martagón Alexandro J, Elias López D, Vargas Vázquez A, et al. La asociación entre la resistencia a la insulina y la rigidez arterial en pacientes mexicanos sin diabetes mellitus tipo 2 [Internet]. Gac Méd Méx. 2021 [acceso: 01/05/2024]; 157(5):539-47. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016381320210-00500539&lng=es
24. Sung KC. Arterial Stiffness and Incident Diabetes [Internet]. Pulse (Basel). 2023; 12(1):12-8. DOI: 10.1159/000535775
25. Revueltas Agüero M, Molina Esquivel E. La diabetes mellitus como factor de riesgo cardiovascular [Internet]. AMC. 2022 [acceso: 06/04/2024]; 26:e8715. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S10250255202200010-0050&lng=es
26. Yang DR, Wang MY, Zhang CL, Wang Y. Endothelial dysfunction in vascular complications of diabetes: a comprehensive review of mechanisms and implications [Internet]. Front Endocrinol (Lausanne). 2024; 15:1359255. DOI: 10.3389/fendo.2024.1359255
27. Muthanna BAB, Sadangi RKM, Hosur BLC, Jain NKC, Monga IS. Sonographic Evaluation of Carotid Intima-Media Thickness and Carotid Plaques in Coronary Artery Disease Patients [Internet]. Journal of Marine Medical Society. 2023; 25(Suppl 1):S58-S63. DOI: 10.4103/jmms.jmms_71_22
28. Cruz Y, Camejo N, Cruz Y, Zúñiga E, Cruz G, Palomo Z. Ecografía Doppler carotídea en pacientes con enfermedad cerebrovascular isquémica [Internet]. Correo Científico Médico. 2021 [acceso: 15/07/2023]; 25(4):19. Disponible en: https://revcocmed.sld.cu/index.php/cocmed/article/view/4031/1994
29. Castro D, Brito NJ, Saab T, García N. Hallazgos del sistema carotídeo mediante ultrasonografía tríplex en pacientes con ictus isquémico [Internet]. Rev Biomed. 2020; 31(3):125-33. DOI: 10.32776/revbiomed.v31i3.819
30. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile. A statement por Health professionals [Internet]. Circulation. 1991; 83:356-62. DOI: 10.1161/01.cir.83.1.356
31. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, de Bac-ker G, et al. SCORE project group. Estimation of ten-year riskof fatal cardiovascular disease in Europe: The SCORE Project [Internet]. Eur Heart J. 2003; 24:987-1003. DOI: 10.1016/s0195-668x(03)00114-3
32. Stevens RJ, Kothari V, Adler AI, Straton IM, Holman RR. United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKDPS risk engine: A model for the risk of coronary heart disease in Type II diabetes (UKPDS 56) [Internet]. Clin Sci (Lon). 2001 [acceso: 06/04/2024]; 101:617-9. DOI: 10.1042/cs1010671
33. Kengne AP, Patel A, Marre M, Travert F, Lievre M, Zoungas S, et al. Contemporary model for cardiovascular risk prediction in people with type 2 diabetes [Internet]. European Journal of Cardiovascular Prevention & Rehabilitation. 2011; 18(3):393-8. DOI: 10.1177/1741826710394270
Published
2024-09-14
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1.
Gallego Galano JM, Pérez Infante Y, García Céspedes ME, Montoya Pedrón A, Hernández Cortés KS. Predictive model of macrovascular complications at the time of diagnosis of patients with type 2 diabetes. Rev Cubana Med Milit [Internet]. 2024 Sep. 14 [cited 2025 Apr. 3];53(3):e024059954. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/59954
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