Serum alpha-1-microglobulin as a predictor of multiple complications in type 2 diabetes mellitus patients

Figure 1 Serum α 1-microglobulin levels in patients with and without different diabetic complications. A: With and without diabetic nephropathy; B: With and without diabetic retinopathy; C: With and without diabetic peripheral neuropathy; D: With and without left ventricular hypertrophy. ^aP < 0.001. DN: Diabetic nephropathy; DR: Diabetic retinopathy; DPN: Diabetic peripheral neuropathy; LVH: Left ventricular hypertrophy; α1-MG: Alpha-1-microglobulin.

Figure 2 Association of the serum alpha-1-microglobulin level with the risk of different diabetic complications according to restricted cubic splines. A: Diabetic nephropathy; B: Diabetic retinopathy; C: Diabetic peripheral neuropathy; D: Left ventricular hypertrophy. The models were adjusted for age, sex, body mass index, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, hypertension, hyperlipidaemia, coronary heart disease, antihypertensive drugs, lipid-lowering drugs, antidiabetic drugs, fasting blood glucose, glycated haemoglobin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, uric acid, estimated glomerular filtration rate, alanine aminotransferase, aspartate aminotransferase, white blood cell, C-reactive protein, and left ventricular ejection fraction. reference values for estimation were set at median values of alpha-1-microglobulin. α1-MG: Alpha-1-microglobulin.

Figure 3 Associations of serum alpha-1-microglobulin with the risk of diabetic complications revealed by SHapley Additive exPlanations summary and dependence plots. A: SHapley Additive exPlanations (SHAP) summary plot for diabetic nephropathy (DN); B: SHAP summary plot for diabetic retinopathy (DR); C: SHAP summary plot for diabetic peripheral neuropathy (DPN); D: SHAP summary plot for Left ventricular hypertrophy (LVH); E: SHAP dependence plot for DN; F: SHAP dependence plot for DR; G: SHAP dependence plot for DPN; H: SHAP dependence plot for LVH. In Figure 3A-D, each dot represents a patient, and the X-axis shows the SHAP value of the corresponding feature. For continuous variables, dot color indicates feature values, ranging from blue (low) to red (high). For categorical variables, blue denotes female sex or positive status, and red denotes male sex or negative status. In Figure 3E-H, the red dashed line represents SHAP = 0, and black arrows indicate threshold points. When the SHAP value of alpha-1-microglobulin exceeds zero, it indicates an increased risk of DN, DR, DPN, and LVH. XGBoost: Extreme gradient boosting; SHAP: SHapley Additive exPlanations; DN: Diabetic nephropathy; DR: Diabetic retinopathy; DPN: Diabetic peripheral neuropathy; LVH: Left ventricular hypertrophy; α1-MG: Alpha-1-microglobulin.