Synergistic Impact of Fasting Plasma Glucose and Serum Uric Acid on Peripheral Diabetic Retinopathy Severity in T2DM Patients.
To investigate the synergistic interaction between fasting plasma glucose (FPG) and serum uric acid (SUA) on the severity of peripheral diabetic retinopathy (DR) and to develop a predictive nomogram for severe non-proliferative DR (S-NPDR) in type 2 diabetes mellitus (T2DM) patients.
This retrospective, single-center study included 900 T2DM patients admitted between January 2018 and December 2023. Patients were categorized into groups of No-DR (n = 300), mild to moderate NPDR (n = 350), and S-NPDR (n = 250). S-NPDR was compared against the combined No-DR and mild to moderate NPDR groups (n = 650). Independent predictors were identified via multivariable logistic regression. Additive interaction analysis assessed the synergistic effect of FPG and SUA. A predictive nomogram was developed and internally validated using 1000 bootstrap resamples.
Seven independent predictors of S-NPDR were identified in the final model: higher FPG (odds ratio [OR] = 1.701), SUA (OR = 1.062 per 10 µmol/L), urinary albumin-to-creatinine ratio (UACR; OR = 1.046 per 10 mg/g), high-sensitivity C-reactive protein (hs-CRP; OR = 1.191), lower subfoveal choroidal thickness (SFCT; OR = 1.330 per 10-µm decrease), lower serum albumin (ALB; OR = 1.153 per 1-g/L decrease), and the interaction between FPG and SUA (OR = 2.710, P < 0.001). A strong synergistic interaction was confirmed (adjusted OR for high FPG/high SUA = 17.56; relative excess risk due to interaction [RERI] = 12.58). The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUC] = 0.925) and good calibration (Hosmer-Lemeshow P = 0.418).
Concurrent elevations of FPG and SUA are strongly associated with an increased likelihood of S-NPDR. Patients with both markers elevated represent a high-risk group requiring intensive monitoring.
The validated nomogram enables personalized risk stratification, guiding targeted clinical management to prevent vision-threatening DR complications.
This retrospective, single-center study included 900 T2DM patients admitted between January 2018 and December 2023. Patients were categorized into groups of No-DR (n = 300), mild to moderate NPDR (n = 350), and S-NPDR (n = 250). S-NPDR was compared against the combined No-DR and mild to moderate NPDR groups (n = 650). Independent predictors were identified via multivariable logistic regression. Additive interaction analysis assessed the synergistic effect of FPG and SUA. A predictive nomogram was developed and internally validated using 1000 bootstrap resamples.
Seven independent predictors of S-NPDR were identified in the final model: higher FPG (odds ratio [OR] = 1.701), SUA (OR = 1.062 per 10 µmol/L), urinary albumin-to-creatinine ratio (UACR; OR = 1.046 per 10 mg/g), high-sensitivity C-reactive protein (hs-CRP; OR = 1.191), lower subfoveal choroidal thickness (SFCT; OR = 1.330 per 10-µm decrease), lower serum albumin (ALB; OR = 1.153 per 1-g/L decrease), and the interaction between FPG and SUA (OR = 2.710, P < 0.001). A strong synergistic interaction was confirmed (adjusted OR for high FPG/high SUA = 17.56; relative excess risk due to interaction [RERI] = 12.58). The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve [AUC] = 0.925) and good calibration (Hosmer-Lemeshow P = 0.418).
Concurrent elevations of FPG and SUA are strongly associated with an increased likelihood of S-NPDR. Patients with both markers elevated represent a high-risk group requiring intensive monitoring.
The validated nomogram enables personalized risk stratification, guiding targeted clinical management to prevent vision-threatening DR complications.