Tyypin 1 diabeteksen matemaattisista ennustamismenetelmistä

Tutkielmassa käsitellään matemaattisia ennustamismenetelmiä, jotka soveltuvat tyypin 1 diabeteksen ennustamiseen. Aluksi esitellään menetelmiä, jotka soveltuvat puuttuvia havaintoja sisältävien aineistojen paikkaamiseen. Paikattua aineistoa on mahdollista analysoida useilla tavallisilla tilastollisilla menetelmillä, jotka sopivat täydellisiin aineistoihin. Seuraavaksi pyritään mallintamaan aineistoa semiparametrisilla komponenttimalleilla (eng. mixture model), jolloin mallin muotoa ei ole tiukasti etukäteen rajoitettu. Sen jälkeen sovelletaan kolmea luokittelevaa ennustajaa: logistista regressiomallia, eteenpäinsyöttävää yhden piilotason neuroverkkoa ja SVM-menetelmää (eng. support vector machine). Esiteltäviä menetelmiä on sovellettu todelliseen aineistoon, joka on kerätty Turun yliopistossa käynnissä olevassa tutkimusprojektissa. Projektin tavoitteena on oppia ennustamaan ja ehkäisemään tyypin 1 diabetesta (Type 1 diabetes prediction and prevention project, lyh. DIPP-projekti). Erityisesti projektissa on pyritty löytämään uusia tuntemattomia taudinaiheuttajia. Tässä tutkielmassa paneudutaan sen sijaan kerätyn havaintoaineiston matemaattisiin analysointimenetelmiin. Parhaat ennusteet saatiin perinteisellä logistisella regressiomallilla. Tutkielmassa kuitenkin todetaan, että tulevaisuudessa on mahdollista löytää parempia ennustajia parantamalla muita edellä mainittuja menetelmiä. Erityisesti SVM-menetelmä ansaitsisi lisähuomiota, sillä tässä tutkielmassa sitä sovellettiin vain kaikkein yksinkertaisimmassa muodossa.

Factors predicting mortality in type 2 diabetes. With special reference to physical exercise, blood pressure, proteinuria, inflammation and P wave duration

Background: Type 2 diabetes patients have a 2-4 fold risk of cardiovascular disease (CVD) compared to the general population. In type 2 diabetes, several CVD risk factors have been identified, including obesity, hypertension, hyperglycemia, proteinuria, sedentary lifestyle and dyslipidemia. Although much of the excess CVD risk can be attributed to these risk factors, a significant proportion is still unknown. Aims: To assess in middle-aged type 2 diabetic subjects the joint relations of several conventional and non-conventional CVD risk factors with respect to cardiovascular and total mortality. Subjects and methods: This thesis is part of a large prospective, population based East-West type 2 diabetes study that was launched in 1982-1984. It includes 1,059 middle-aged (45-64 years old) participants. At baseline, a thorough clinical examination and laboratory measurements were performed and an ECG was recorded. The latest follow-up study was performed 18 years later in January 2001 (when the subjects were 63-81 years old). The study endpoints were total mortality and mortality due to CVD, coronary heart disease (CHD) and stroke. Results: Physically more active patients had significantly reduced total, CVD and CHD mortality independent of high-sensitivity C-reactive protein (hs-CRP) levels unless proteinuria was present. Among physically active patients with a hs-CRP level >3 mg/L, the prognosis of CVD mortality was similar to patients with hs-CRP levels ≤3 mg/L. The worst prognosis was among physically inactive patients with hs-CRP levels >3 mg/L. Physically active patients with proteinuria had significantly increased total and CVD mortality by multivariate analyses. After adjustment for confounding factors, patients with proteinuria and a systolic BP <130 mmHg had a significant increase in total and CVD mortality compared to those with a systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with a systolic BP <130 mmHg and ≥160 mmHg. Among patients without proteinuria, a systolic BP <130 mmHg was associated with a non-significant reduction in mortality. A P wave duration ≥114 ms was associated with a 2.5-fold increase in stroke mortality among patients with prevalent CHD or claudication. This finding persisted in multivariable analyses. Among patients with no comorbidities, there was no relationship between P wave duration and stroke mortality. Conclusions: Physical activity reduces total and CVD mortality in patients with type 2 diabetes without proteinuria or with elevated levels of hs-CRP, suggesting that the anti-inflammatory effect of physical activity can counteract increased CVD morbidity and mortality associated with a high CRP level. In patients with proteinuria the protective effect was not, however, present. Among patients with proteinuria, systolic BP <130 mmHg may increase mortality due to CVD. These results demonstrate the importance of early intervention to prevent CVD and to control all-cause mortality among patients with type 2 diabetes. The presence of proteinuria should be taken into account when defining the target systolic BP level for prevention of CVD deaths. A prolongation of the duration of the P wave was associated with increased stroke mortality among high-risk patients with type 2 diabetes. P wave duration is easy to measure and merits further examination to evaluate its importance for estimation of the risk of stroke among patients with type 2 diabetes.

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