A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: A cross-sectional study based on a large community survey in China

• Published in: PloS one 2020-08, Vol.15 (8), p.e0236957-e0236957
• Main Authors: Xue, Mingyue, Liu, Li, Wang, Shuxia, Su, Yinxia, Lv, Kun, Zhang, Mingchen, Yao, Hua
• Format: Article
• Language: English
• Subjects: Abdomen; Angina pectoris; Arteriosclerosis; Atherosclerosis; Biology and Life Sciences; Blood pressure; Calibration; Cardiovascular disease; Cardiovascular diseases; Chinese medicine; Cross-sectional studies; Determinants; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diagnosis; Epidemiology; Eye diseases; Gallbladder; Gallbladder diseases; Glucose; Group dynamics; Health risks; Health screening; Heart; Hospitals; Hypertension; Kidney diseases; Laboratories; Medicine and Health Sciences; Methods; Nomograms; Nomographs; Nomography (Mathematics); Patients; Physical Sciences; Prediction models; Public health; Questionnaires; Regression analysis; Research and Analysis Methods; Risk analysis; Risk factors; Smoking; Social Sciences; Socio-economic aspects; Socioeconomics; Software; Statistical analysis; Studies; Type 2 diabetes; Ultrasonic imaging; Variables; Vascular diseases
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236957

Objectives Compared with unaffected individuals, patients with type 2 diabetes (T2DM) have higher risk of hypertension, and diabetes combined with hypertension can lead to server cardiovascular disease. Therefore, the purpose of this study was to establish a simple nomogram model to identify the determinants of hypertension in patients with T2DM and to quickly calculate the probability of hypertension in individuals with T2DM. Materials and methods A total of 643,439 subjects participating in the national physical examination has been recruited in this cross-sectional study. After excluding unqualified subjects, 30,507 adults with T2DM were included in the final analysis. 21,355 and 9,152 subjects were randomly assigned to the model developing group and validation group, respectively, with a ratio of 7:3. The potential risk factors used in this study to assess hypertension in patients with T2DM included questionnaire investigation and physical measurement variables. We used the least absolute shrinkage and selection operator models to optimize feature selection, and the multivariable logistic regression analysis was for predicting model. Discrimination and calibration were assessed using the receiver operating curve (ROC) and calibration curve. Results The results showed that the major determinants of hypertension in patients with T2DM were age, gender, drinking, exercise, smoking, obesity and atherosclerotic vascular disease. The area under ROC curve of developing group and validation group are both 0.814, indicating that the prediction model owns high disease recognition ability. The p values of the two calibration curves are 0.625 and 0.445, suggesting that the nomogram gives good calibration. Conclusion The individualized nomogram model can facilitate improved screening and early identification of patients with hypertension in T2DM. This procedure will be useful in developing regions with high epidemiological risk and poor socioeconomic status just like Urumqi, in Northern China.