Nomogram for Predicting Risk of Digestive Carcinoma Among Patients with Type 2 Diabetes

Figures & data

Table 1 Characteristics of Patients in the Primary and Validation Cohorts

Variable	Primary Cohort	Validation Cohort	P-value
Age, years	59 (53,65)	61 (54,66)	0.054
Comorbidities
Hypertension, yes, N (%)	260 (39.7%)	99 (36.0%)	0.291
Coronary artery disease, yes, N (%)	156 (23.8%)	55 (20.0%)	0.205
Cerebrovascular disease, yes, N (%)	126 (19.2%)	48 (17.5%)	0.525
Family history of carcinomas, yes, N (%)	89 (13.6%)	34 (12.4%)	0.615
Diabetes duration, month	69 (24,120)	81 (27,135)	0.962
Sex, N (%)
Male	380 (58.0%)	164 (59.6%)	0.647
Female	275 (42.0%)	111 (40.4%)
Blood glucose-lowering drugs
Insulin, yes, N (%)	125 (19.1%)	40 (14.5%)	0.098
Thiazolidinediones, yes, N (%)	8 (1.2%)	8 (2.9%)	0.071
Alpha glucosidase inhibitors, yes, N (%)	72 (11.0%)	36 (13.1%)	0.362
Sulfonylureas, yes, N (%)	85 (13.0%)	44 (16.0%)	0.224
Metformin, yes, N (%)	109 (16.6%)	57 (20.7%)	0.138
Combination of oral drugs and insulin, yes, N (%)	26 (4.0%)	8 (2.9%)	0.432
Combination of oral drugs, yes, N (%)	66 (10.1%)	42 (15.3%)	0.024
Smoking, yes, N (%)	223 (34.0%)	95 (34.5%)	0.883
BMI, N (%)
Normal	385 (58.8%)	145 (52.7%)	0.234
Overweight	211 (32.2%)	101 (36.7%)
Obese	59 (9.0%)	29 (10.5%)
Digestive carcinoma type, N (%)			0.620
Esophageal cancer	9 (1.4%)	7 (2.5%)
Gastric cancer	23 (3.5%)	11 (4.0%)
Primary liver cancer	114 (17.4)	45 (16.4%)
Pancreatic cancer	7 (1.1%)	5 (1.8%)
Colorectal cancer	95 (14.5%)	44 (16.0%)

Notes: 24 ≤BMI<28 kg/m² is defined as overweight and ≥28 kg/m² is defined as obese for the Chinese population.

Abbreviation: BMI, body mass index.

Table 2 Univariate Logistic Regression Analysis of Factors Relating to Digestive Carcinomas in the Primary Cohort

Variable	β	P-value	Odds Ratio (95% CI)
Sex	−1.916	<0.001	0.147 (0.099–0.218)
Age	−0.548	0.006	1.024 (1.007–1.042)
Comorbidities
Hypertension	0.276	0.089	1.318 (0.958–1.814)
Coronary artery disease	0.315	0.093	1.370 (0.949–1.977)
Cerebrovascular disease	0.365	0.070	1.440 (0.971–2.138)
Diabetes duration	0.004	0.004	1.004 (1.001–1.006)
Family history of carcinomas	0.132	0.572	1.141 (0.722–1.805)
Smoking	0.729	<0.001	2.074 (1.487–2.893)
BMI	−0.462	<0.001	0.630 (0.486–0.816)
Use of blood glucose-lowering drugs
Insulin	0.706	<0.001	2.207 (1.366–3.006)
Thiazolidinediones	−0.557	0.497	0.573 (0.115–2.861)
Alpha glucosidase inhibitors	−0.026	0.921	0.975 (0.586–1.622)
Sulfonylureas	−0.248	0.318	0.780 (0.479–1.270)
Metformin	−0.045	0.838	0.956 (0.623–1.468)
Combination of oral drugs and insulin	0.572	0.154	1.771 (0.807–3.886)
Combination of oral drugs	−0.238	0.392	0.788 (0.458–1.359)

Abbreviation: BMI, body mass index.

Table 3 Multivariate Logistic Regression Analysis of Factors Relating to Digestive Carcinomas in the Primary Cohort

Variable	β	P-value	Odds Ratio (95% CI)
Sex	−2.089	<0.001	0.124 (0.078–0.198)
Age	0.021	0.029	1.021 (1.002–1.040)
Insulin	0.591	0.009	1.806 (1.162–2.806)
Smoking	−0.393	0.065	0.675 (0.444–1.025)
BMI	−0.364	0.014	0.695 (0.521–0.928)
Diabetes duration	0.002	0.122	1.002 (0.999–1.005)

Notes: Hosmer–Lemeshow test: χ²=6.962, P=0.541. C-index: 0.747 (0.718–0.791).

Figure 1 Nomogram developed on the basis of the primary cohort, with sex, age, insulin use, and BMI incorporated.

Figure 2 Calibration curves for the nomogram in the primary cohort. The blue dotted line represents the entire cohort (n=655), and the red solid line is the result after bias-correction by bootstrapping (1000 repetitions), indicating nomogram performance.

Figure 3 Calibration curves for the nomogram in the validation cohort. The blue dotted line represents the entire cohort (n=275), and the red solid line is the result after bias-correction by bootstrapping (1000 repetitions), indicating nomogram performance.

Figure 4 Decision curve analysis for the nomogram.