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A nomogram integrating HbA1c, sleep quality, social support, and vision-related quality of life predicts depression risk in patients with type 2 diabetic retinopathy

This cross-sectional study of 490 diabetic retinopathy patients found that a nomogram combining four predictors (HbA1c, PSQI score, SSRS score, and VRQoL score) achieved excellent discrimination for depression risk (AUC=0.918 in training, 0.867 in internal validation, 0.875 in temporal validation). The prevalence of depressive symptoms was 29.18%. The nomogram can aid early screening of high-risk individuals.

Last updated: Aug 8, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Vision-Focused Nomogram for Assessing the Risk of Depression in Diabetic Retinopathy: Integrating Visual Function, Metabolic Factors and Psychosocial Status.

observational

Tang M, Wang J, Yang Y, Cheng R, Jiang X, Zhu J · Diabetes, metabolic syndrome and obesity : targets and therapy (2026)

Participants: N/A
Duration: Cross-sectional (data collected from January 2020 to March 2025)
Intervention: Nomogram-based risk prediction model (not an intervention)
Outcome: Depression risk (depressive symptoms assessed via standard criteria)
Effect Size: AUC=0.918 (training), 0.867 (internal validation), 0.875 (temporal validation)
Population: Patients with type 2 diabetic retinopathy (n=490, mean age not specified)

Result:

PubMed: 42549345DOI: 10.2147/DMSO.S610034

Mechanism Graph

Higher HbA1c (OR=1.716) indicates poor glycemic control, which may contribute to depression via metabolic and vascular pathways
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Higher PSQI score (OR=1.306) reflects poor sleep quality, which is a known risk factor for depression
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Lower SSRS score (OR=0.883) indicates reduced social support, increasing depression vulnerability
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Higher VRQoL score (OR=1.138) suggests worse vision-related quality of life, leading to psychological distress and depression

Limitations

  • ⚠Cross-sectional design prevents causal inference
  • ⚠Single-center study with internal and temporal validation from the same center, limiting generalizability
  • ⚠No external validation from other centers or diverse populations

Frequently Asked Questions

What is the prevalence of depression in diabetic retinopathy patients?▼

The prevalence was 29.18% (143 out of 490 patients) in this study.

Which factors are most important for predicting depression in diabetic retinopathy?▼

The four independent predictors are HbA1c, sleep quality (PSQI), social support (SSRS), and vision-related quality of life (VRQoL). SHAP analysis identified VRQoL as the most influential predictor.

How accurate is the nomogram in predicting depression risk?▼

The nomogram showed excellent discrimination with AUCs of 0.918 in the training cohort, 0.867 in internal validation, and 0.875 in temporal validation.

Can this nomogram be used in clinical practice?▼

Yes, it is designed as an interpretable tool for early screening of high-risk DR patients, but external validation is needed before widespread use.

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References

  1. 1.Tang M, Wang J, Yang Y, Cheng R, Jiang X, Zhu J. "Vision-Focused Nomogram for Assessing the Risk of Depression in Diabetic Retinopathy: Integrating Visual Function, Metabolic Factors and Psychosocial Status.." Diabetes, metabolic syndrome and obesity : targets and therapy, 2026. PMID: 42549345 DOI: 10.2147/DMSO.S610034
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.