Glycemic and lipid variability for predicting complications and mortality in diabetes mellitus using machine learning
Open accessAbstract
Introduction: Recent studies have reported that HbA1c and lipid variability is useful for risk stratification in diabetes mellitus. The present study evaluated the predictive value of the baseline, subsequent mean of at least three measurements and variability of HbA1c and lipids for adverse outcomes. Methods: This retrospective cohort study consists of type 1 and type 2 diabetic patients who were prescribed insulin at outpatient clinics of Hong Kong public hospitals, from 1st January to 31st December 2009. Standard deviation (SD) and coefficient of variation were used to measure the variability of HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride. The primary outcome is all-cause mortality. Secondary outcomes were diabetes-related complications. Result: The study consists of 25,186 patients (mean age = 63.0, interquartile range [IQR] of age = 15.1 years, male = 50%). HbA1c and lipid value and variability were significant predictors of all-cause mortality. Higher HbA1c and lipid variability measures were associated with increased risks of neurological, ophthalmological and renal complications, as well as incident dementia, osteoporosis, peripheral vascular disease, ischemic heart disease, atrial fibrillation and heart failure ( p < 0.05). Significant association was found between hypoglycemic frequency ( p < 0.0001), HbA1c ( p < 0.0001) and lipid variability against baseline neutrophil-lymphocyte ratio (NLR). Conclusion: Raised variability in HbA1c and lipid parameters are associated with an elevated risk in both diabetic complications and all-cause mortality. The association between hypoglycemic frequency, baseline NLR, and both HbA1c and lipid variability implicate a role for inflammation in mediating adverse outcomes in diabetes, but this should be explored further in future studies.
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Lee et al. (2021) found that higher HbA1c and lipid measurements were associated with an increased risk of complications and various comorbidities.
“Lee et al. (2021) found that higher HbA1c and lipid measurements were associated with an increased risk of complications and various comorbidities.”
From Artificial intelligence based prediction models for individuals at risk of multiple diabetic complications: A systematic review of the literature (2022) · cites this paper as Lee et al. (2021)
The Abstract’s Results and the Conclusion (page numbers unavailable) associate higher HbA1c and lipid *variability* with complications and other adverse outcomes, while the claim says higher measurements. The Results section reports that elevated mean total cholesterol predicts most adverse outcomes, but higher HDL-C generally lowers risk; the Discussion also describes non-linear relationships for HbA1c and lipid levels. The claim therefore overgeneralizes the findings about measurement levels. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor T2DM patients, glycemic or lipid values and their variability can significantly predict all-cause mortality and the occurrence of complications, including micro- and macrovascular complications.
“For T2DM patients, glycemic or lipid values and their variability can significantly predict all-cause mortality and the occurrence of complications, including micro- and macrovascular complications [7, 8].”
From The Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (2021) · cites this paper as [8]
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Mui, J. V., Zhou, J., Lee, S., Leung, K. S. K., Lee, T. T. L., Chou, O. H. I., Tsang, S. L., Wai, A. K. C., Liu, T., Wong, W. T., et al. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.747620 · Cited by 114 · see citing works
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Self-citationZhou, J., Zhang, G., Chang, C., Chou, O. H. I., Lee, S., Leung, K. S. K., Wong, W. T., Liu, T., Wai, A. K. C., Cheng, S. H., et al. (2022) · Acta Diabetologica · doi:10.1007/s00592-021-01841-4 · Cited by 36 · see citing works
Self-citationLee, S., Zhou, J., Leung, K. S. K., Wu, W. K. K., Wong, W. T., Liu, T., Wong, I. C. K., Jeevaratnam, K., Zhang, Q., & Tse, G. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001950 · Cited by 36 · see citing works
Self-citationLee, S., Jeevaratnam, K., Liu, T., Chang, D., Chang, C., Wong, W. T., Wong, I. C. K., Lip, G. Y. H., & Tse, G. (2021) · Clinical Cardiology · doi:10.1002/clc.23728 · Cited by 30 · see citing works
Self-citationHbA1c Variability and the Risk of Dementia in Patients with Diabetes: A Meta‐Analysis
Song, J., Bai, H., Xu, H., Xing, Y., & Chen, S. (2022) · International Journal of Clinical Practice · doi:10.1155/2022/7706330 · Cited by 27 · see citing works
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Self-citationChan, J. S. K., Satti, D. I., Lee, Y. H. A., Hui, J. M. H., Lee, T. T. L., Chou, O. H. I., Wai, A. K. C., Ciobanu, A., Liu, Y., Liu, T., et al. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac097 · Cited by 25 · see citing works
Self-citationIdentifying Disease and Diagnosis in Females Using Machine Learning
Pramanik, S., & Bandyopadhyay, S. K. (2023) · IGI Global eBooks · doi:10.4018/978-1-7998-9220-5.ch187 · Cited by 25 · see citing works
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A Pragmatic Comparison of Supervised Machine Learning Classifiers for Disease Diagnosis
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Type 2 cytokines promote angiogenesis in ischemic muscle via endothelial IL-4Rα signaling
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Self-citationHukportie, D. N., Li, F., Zhou, R., Zheng, J., Wu, X., Zou, M., & Wu, X. (2022) · Journal of Diabetes · doi:10.1111/1753-0407.13273 · Cited by 16 · see citing works
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Self-citationHigh Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis
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HbA1c variability associated with dementia risk in people with type 2 diabetes
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Self-citationGlycemic variability and the risk of atrial fibrillation: a meta-analysis
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Gender- and Age-Specific Associations of Visit-to-Visit Blood Pressure Variability With Anxiety
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Association of Visit‐to‐Visit Variability in Fasting Plasma Glucose with Digestive Cancer Risk
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Self-citationA scoping review of digital solutions in diabetes outpatient care: Functionalities and outcomes
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Artificial Intelligence in Personalized Medicine for Diabetes Mellitus: A Narrative Review
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Self-citationLee, S., Huang, H. Y. R., Lee, T. T. L., Chung, C. T., Chou, O. H. I., Leung, K. S. K., Wai, A. K. C., Wong, W. T., Liu, T., Chang, C., et al. (2022) · Life · doi:10.3390/life12121956 · Cited by 4 · see citing works
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Self-citationRole of angiotensin receptor-neprilysin inhibitor in diabetic complications
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Self-citationLiu, T., Jin, Y., Yang, X., Tong, Z., & Dong, M. (2023) · Drug and Chemical Toxicology · doi:10.1080/01480545.2023.2217700 · Cited by 2 · see citing works
Self-citationLipid Variability and the Risk of Incident Peripheral Artery Disease
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Risk factors of dementia in type 2 diabetes mellitus: The Hong Kong diabetes study
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Self-citationLee, S., Liu, T., Chung, C. T., Reinhold, J., Vassiliou, V. S., & Tse, G. (2024) · npj Metabolic Health and Disease · doi:10.1038/s44324-024-00012-7 · Cited by 2 · see citing works
Self-citationAn Optimized Deep Learning-based framework for predicting diabetes mellitus using FFNN
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Self-citationDiabetics Prediction Using Ensembled and Hyper Tuned Machine Learning Models
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A Comprehensive Survey on Diabetes Forecasting Using ML
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Cardiovascular Research Mentorship Platforms
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Self-citationZhou, J., Lee, S., Adhikari, G., Wong, W. T., Waleed, K. B., Liu, T., Wong, I. C. K., Cheung, B. M. Y., Tse, G., & Zhang, Q. (2021) · medRxiv · doi:10.1101/2021.11.27.21266928
Self-citationSakr, B. (2021) · Evidence Based Women s Health Journal · doi:10.21608/ebwhj.2021.78011.1139
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Self-citationClinical applications of machine learning in heart failure
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Self-citationLinks Between Glucose and Lipoproteins
Jenkins, A. J. (2023) · Contemporary diabetes · doi:10.1007/978-3-031-26681-2_3
Lipids and Diabetic Retinopathy
Jenkins, A. J. (2023) · Contemporary diabetes · doi:10.1007/978-3-031-26681-2_16
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Self-citationLipid Swings Provoke Vascular Inflammation
Jeon, J. (2024) · Endocrinology and Metabolism · doi:10.3803/enm.2024.302
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Self-citationArtificial intelligence approaches for risk stratification of diabetic kidney disease
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Self-citationGhosh, I., Singh, K., Jayaprakash, V., & Jayapalan, S. (2024) · Journal of Research in Pharmacy · doi:10.29228/jrp.795
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Homebound status and glycemic control among older adults: results from a national survey
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- Authors
- Lee, S., Zhou, J., Wong, W. T., Liu, T., Wu, W. K. K., Wong, I. C. K., Zhang, Q., & Tse, G.
- Affiliations
- City University of Hong Kong (HK)
- Chinese University of Hong Kong (HK)
- Second Hospital of Tianjin Medical University (CN)
- University of Surrey (GB)
- Corresponding author
- Zhang, Qingpeng
- Tse, Gary
- ORCID
- Venue
- BMC Endocrine Disorders
- Published
- 2021-05-04
- Volume
- 21
- Issue
- 1
- Pages
- 94-94
- ISSN
- 1472-6823 (ISSN-L)
- PMC
- PMC8097996
- OpenAlex
- W3158961545
- Cited by
- 97
- References
- 87
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 17 · 2023: 27 · 2022: 21 · 2021: 15
- FWCI
- 14.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Endocrine Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Kent Academic Repository (University of Kent) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- CityU Scholars (submittedVersion, cc-by)
- Funders
- National Natural Science Foundation of China (71972164, 16171991)
- Innovation and Technology Commission (MHP/081/19)
- Food and Health Bureau (16171991, 71972164)
- Innovation and Technology Fund (MHP/081/19)
- Health and Medical Research Fund (71972164, 16171991)
- National Key Research and Development Program of China (2019YFE0198600)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- glycemic variability, lipid variability, HbA1c, diabetes mellitus, type 1 diabetes, type 2 diabetes, all-cause mortality, diabetes complications, hypoglycemia, neutrophil-to-lymphocyte ratio, inflammation, risk stratification, insulin-treated patients
- MeSH terms
- Machine Learning, Adult, Aged, Blood Glucose, Computer Simulation, Diabetes Mellitus, Female, Glycated Hemoglobin, Hong Kong, Humans, Lipids, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Survival Analysis, Diabetes Complications
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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