A semi-parametric mixed models for longitudinally measured fasting blood sugar level of adult diabetic patients
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Authors
Tafere Tilahun Aniley
Wondwosen Kassahun Yime
Zelalem Mehari Nigusie
Yimer, Belay Birlie
Legesse Kassa Debusho
Issue Date
2019-01-10
Type
Article
Language
en
Keywords
Diabetes mellitus , Fasting blood sugar , Linear mixed model , Semi-parametric mixed model
Alternative Title
Abstract
Background: At the diabetic clinic of Jimma University Specialized Hospital, health professionals provide regular
follow-up to help people with diabetes live long and relatively healthy lives. Based on patient condition, they also
provide interventions in the form of counselling to promote a healthy diet and physical activity and prescribing
medicines. The main purpose of this study is to estimate the rate of change of fasting blood sugar (FBS) profile
experienced by patients over time. The change may help to assess the effectiveness of interventions taken by the
clinic to regulate FBS level, where rates of change close to zero over time may indicate the interventions are good
regulating the level.
Methods: In the analysis of longitudinal data, the mean profile is often estimated by parametric linear mixed effects
model. However, the individual and mean profile plots of FBS level for diabetic patients are nonlinear and imposing
parametric models may be too restrictive and yield unsatisfactory results. We propose a semi-parametric mixed
model, in particular using spline smoothing to efficiently analyze a longitudinal measured fasting blood sugar level of
adult diabetic patients accounting for correlation between observations through random effects.
Results: The semi-parametric mixed models had better fit than the linear mixed models for various variance structures
of subject-specific random effects. The study revealed that the rate of change in FBS level in diabetic patients, due to
the clinic interventions, does not continue as a steady pace but changes with time and weight of patients.
Conclusions: The proposed method can help a physician in clinical monitoring of diabetic patients and to assess the
effect of intervention packages, such as healthy diet, physical activity and prescribed medicines, because
individualized curve may be obtained to follow patient-specific FBS level trends.
Description
Citation
Aniley, T., Debusho, L., Nigusie, Z. et al. A semi-parametric mixed models for longitudinally measured fasting blood sugar level of adult diabetic patients. BMC Medical Research Methodology 19(1):13 (2019)