{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:02:37Z","timestamp":1790226157834,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013076","name":"National Major Science and Technology Projects of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013076","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of irreversible vision loss among working-age adults, making early detection essential for preventing permanent visual impairment. This study aimed to identify early-stage DR in patients with type 2 diabetes mellitus (T2DM) using a multimodal deep learning (DL) approach integrating ultra-widefield optical coherence tomography angiography (UW-OCTA) images with clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled patients with T2DM from an urban tertiary hospital and a community primary care setting between July 2024 and April 2026. Baseline demographic and laboratory data and 26 \u00d7 21\u00a0mm UW-OCTA images were obtained. Automatically segmented UW-OCTA slabs were compared to identify the most discriminative layer. Clinical variables were selected using between-group comparisons, XGBoost-based Shapley additive explanations (SHAP), and multivariable logistic regression. Selected clinical variables and UW-OCTA image features were integrated into a multimodal model. Performance was evaluated in internal test and external validation sets using receiver operating characteristic analysis. Gradient-weighted class activation mapping (Grad-CAM) was used for visualization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1,676 patients were included: 1,047 and 453 tertiary-care patients formed the training and internal test sets, and 176 community-based patients formed the external validation set. Diabetes duration, glycated hemoglobin, low-density lipoprotein cholesterol and systolic blood pressure were independently associated with early-stage DR. The retinal slab showed the best image-only performance with AUCs of 0.906 (95%CI: 0.870-0.942) and 0.828 (95%CI: 0.725-0.931) in the internal and external sets. The multimodal model achieved AUCs of 0.921 (95%CI: 0.887-0.954) and 0.849 (95%CI: 0.760-0.953), outperforming image-only and clinical-only models. Grad-CAM highlighted macular and peripheral retinal regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integrating UW-OCTA with clinical factors improved early-stage DR identification in T2DM and may support non-invasive risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1941613","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:39:36Z","timestamp":1790224776000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integration of ultra-widefield optical coherence tomography angiography images and clinical indicators for identifying early-stage diabetic retinopathy in type 2 diabetes"],"prefix":"10.3389","volume":"17","author":[{"given":"Cong","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoxuan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianpeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangwen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengye","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, 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