Time to Progression to Proliferative Diabetic Retinopathy in Patients With Type 2 Diabetes
Authors' conclusion
The survival models developed and validated in this study demonstrated good discrimination across internal and external test sets and good calibration up to 2 years. These models have the potential to enable earlier identification, personalized follow-up, and targeted resource allocation for high-risk patients.
Study context
- Population
- Adults ≥18 years with T2D and nonproliferative DR (nonproliferative diabetic retinopathy (NPDR)) or diabetic macular edema (DME), University of California (UC) Health Data Warehouse, March 1, 2012, to July 3, 2024; mean age 66.7 years
- Participants
- 7,739 adults
- Outcome
- Time from index date (first DR diagnosis) to first proliferative DR (PDR) diagnosis or last in-person visit; model performance by Harrell C index
Methodological detailsdeidentified electronic health record data, internal and external validation, survival models: Cox proportional hazards, Cox with LASSO, random survival forest, Cohort split by UC Health site into development and external test sets; development set split into internal training (75%) and test (25%) sets
- Deidentified electronic health record data
- Internal and external validation
- Survival models: Cox proportional hazards, Cox with LASSO, random survival forest
- Cohort split by UC Health site into development and external test sets; development set split into internal training (75%) and test (25%) sets
Performance
As reported in the abstract
Predictive discrimination of survival models (C index), internal and external test sets
C index, all survival models
0.73-0.75
Cox proportional hazards and RSF models had good calibration
up to 2 years
Further findings
Proliferative diabetic retinopathy (PDR) progression
- Patients with PDR progression
- 723 (9.3%)
- Progression time, mean (SD)
- 1.89 (2.09) years
Key independent risk factors across all models
- Baseline age, race, ethnicity, DME, NPDR severity, mean HbA1c and diabetic nephropathy
Original publication
Time to Progression to Proliferative Diabetic Retinopathy in Patients With Type 2 Diabetes. JAMA Netw Open. Published 1 July 2025. doi:10.
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