Cited by 97Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and Management

Glycemic and lipid variability for predicting complications and mortality in diabetes mellitus using machine learning

Open access
Lee, Sharen, Zhou, Jiandong, Wong, Wing Tak, Liu, Tong, Wu, William K. K., Wong, Ian Chi Kei, Zhang, Qingpeng, Tse, Gary·2021·BMC Endocrine Disorders

Abstract

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12902-021-00751-4

Cites

87 of 87 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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 measured
  • 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.

    “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].”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Cited by

Sorted by citations

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
Venue
BMC Endocrine Disorders
Published
2021-05-04
Volume
21
Issue
1
Pages
94-94
ISSN
1472-6823 (ISSN-L)
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
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 ›

Are you an author, or do you see a problem with this page? Request a review