{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:00:22Z","timestamp":1785214822437,"version":"3.55.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Clin. Diabetes Healthc."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To construct and validate a dynamic prediction model for diabetic retinopathy (DR) risk in adults with adult-onset type 1 diabetes mellitus (T1DM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal cohort of 572 adult-onset T1DM patients from a tertiary hospital in Tianjin, China (2014\u20132023) was analyzed. LASSO regression and multivariable Cox regression with time-varying covariates (duration and HbA1c) were used to identify independent predictors of DR and to construct a nomogram. Model performance was assessed using the concordance index (C-index), area under the receiver operating characteristic curve (AUC), Brier score, calibration curves, Hosmer-Lemeshow test, and decision curve analysis (DCA). Internal validation was performed by bootstrap resampling (1000 replicates).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariable Cox regression identified diabetic peripheral vascular disease, diabetic kidney disease, metabolic bone disease, dynamic disease duration, time-varying HbA1c, body mass index (BMI), and gender as independent predictors of DR. The dynamic model had a C-index of 0.704 (corrected: 0.681), with 1-, 2-, and 3-year AUCs of 0.704, 0.713, and 0.732, respectively. Brier scores were all &amp;lt;0.1. Calibration was acceptable at 2 and 3 years; the 1-year calibration slope was elevated (1.895). Hosmer-Lemeshow test P-values were &amp;gt;0.05 at all time points. The dynamic model outperformed a traditional static model in both discrimination and calibration. DCA showed favorable net clinical benefit for 2- and 3-year predictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates the feasibility of dynamic DR risk assessment in adult-onset T1DM. The proposed nomogram may serve as an auxiliary tool for predicting 2- to 3-year DR risk, supporting nurses in risk stratification and individualized screening guidance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcdhc.2026.1873754","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:26:47Z","timestamp":1785212807000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Construction of a dynamic prediction model for diabetic retinopathy risk in adults with adult-onset type 1 diabetes: a real-world longitudinal cohort study"],"prefix":"10.3389","volume":"7","author":[{"given":"Di","family":"Bao","sequence":"first","affiliation":[{"name":"Department of Infection Management, National Health Commission Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of 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