MATHEMATICAL MODELING OF ASSESSMENT OF THE PROBABILITY OF THE DEVELOPMENT AND PROGRESSING OF DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES
Authors: Kyryliuk M.L. , Suk S.A. 
Published: January 2024

Background. The participation of fractalkine, clusterin and sICAM in the pathogenesis of diabetic complications of the fundus was established. The development of methods of mathematical assessment of the prognosis of the development and course of diabetic macular edema (DME) with the participation of these cytokines is an actual problem of modern ophthalmology and endocrinology.
Aim: To develop the prognostic mathematical models for assessing the probability of development and progression of DME in patients with diabetes mellitus (DM) type 2 based on the study of the content of blood serum fractalkine, clusterin and sICAM-1.
Material and methods. A single-center selective one-moment open observational study of 82 patients (145 eyes) with DME in type 2 diabetes, divided into 4 groups according to the severity of DME, was conducted. The average age of the patients was 65.25±10.85 years, the average duration of diabetes was 14.0±7.05 years (±SD). The concentration of blood serum fractalkine (Frl), clusterin (Cls) and sICAM-1 was determined by the ELISA, and an instrumental examination of the fundus was performed. Multivariate discriminant analysis was used with the “SPSS 9.0” program. Differences at p<0.05 were considered statistically significant. 3 models with linear combinations of the investigated indicators were developed and corresponding formulas of classification functions (FC) were obtained.
Results. Models for assessing the risk of DME development and progression in patients with type 2 DM characterize by the fact that, at the first stage, fix the duration of diabetes mellitus (DD), and measure the concentration of blood serum fractalkine, clusterin, and sICAM-1. Further, with the helpness of ophthalmoscopy, determine the presence and severity of DMN, assigning the code 1 - the presence of concomitant diabetic retinopathy (DRP), the code 2 - the absence of DRP. At the final stage, calculate the classification functions FK1 and FK2 or FK2 and FK3 (depending on the model), compare FK1 with FK2 or FK2 with FK3, and determine which of them is larger according to the appropriate formulas. Moreover, the prognostic decision takes as the choice of the FC that is more important. So, if FK1>FK2, the prognosis is possible the stabilization of the pathological process, and if FK2>FK1 or FK3>FK2, then the prognosis is the probability of progression of the DME.
The main model is presented below:
FK1DME(0) = -111,278 + 8,57411*Frl + 0,562616*Cls + 0,257994*sICAM -0,139202*DD +7,72433*DRP
FK2DME(1) = -101,108 + 8,5887* Frl + 0,544401* Cls + 0,235155*sICAM + +0,0261057*DD + 10,1873*DRP
FK3DME(2+3) = -105,68 + 9,06663* Frl + 0,552074* Cls + 0,241348*sICAM -0,102963*DD + 11,8493*DRP
Conclusion. The informativeness of mathematical models for assessing the prognostic significance of serum cytokines fractalkine, clusterin and sICAM-1 in the development and progression of DME in patients with type 2 diabetes is 62.5-77.5%, depending on the type of model.