Association of rate-pressure product with diabetic retinopathy in patients with type 2 diabetes mellitus: development and internal validation of a nomogram for diabetic retinopathy identification.
RPP is independently associated with prevalent DR in patients with T2DM, and an RPP-based nomogram incorporating disease duration, insulin use, HbA1c, and RPP demonstrates acceptable discrimination and calibration, suggesting clinical utility for DR identification.
Key Findings
Results
Rate-pressure product (RPP) was independently and positively associated with prevalent diabetic retinopathy after full adjustment for confounders.
Per 1-SD increase in RPP was associated with higher odds of DR (OR = 1.292, 95% CI: 1.136–1.469; P < 0.001)
The study included 1,316 hospitalized patients with T2DM, of whom 464 had DR
Multivariable logistic regression was used for the association analysis after LASSO regression for variable selection
The association remained consistent across most subgroups without significant interactions
Results
Restricted cubic spline analysis revealed a significant linear dose-response relationship between RPP and prevalent diabetic retinopathy.
There was a significant overall association between RPP and DR
No evidence of nonlinearity was found (P for nonlinear > 0.05)
A positive dose-response trend was observed (P for trend < 0.001)
RCS analysis was used to assess the shape of the dose-response relationship
Results
A nomogram incorporating disease duration, insulin use, HbA1c, and RPP demonstrated acceptable discrimination for identifying diabetic retinopathy.
The nomogram achieved an AUC of 0.732 in the original sample
Bootstrap-corrected AUC was 0.727, indicating minimal overfitting
The model also showed good calibration and favorable clinical utility as assessed by decision curve analysis
Brier score was used as an additional measure of model performance
Methods
LASSO regression selected disease duration, insulin use, HbA1c, and RPP as the key variables for inclusion in the diabetic retinopathy identification nomogram.
LASSO (Least Absolute Shrinkage and Selection Operator) regression was applied for variable selection among candidate predictors
The final nomogram included four variables: disease duration, using insulin, HbA1c, and RPP
The study population consisted of 1,316 retrospectively enrolled hospitalized patients with T2DM
Internal validation was performed using bootstrap resampling
Results
The association between RPP and prevalent diabetic retinopathy was stable across most patient subgroups with no significant interaction effects detected.
Subgroup analyses were conducted to assess the stability of the RPP–DR association
No significant interactions were found across most subgroups examined
The consistent direction of association across subgroups supports the robustness of the finding
Specific subgroup variables were not detailed in the abstract but analyses were described as comprehensive
What This Means
This research suggests that a measure called the rate-pressure product (RPP) — calculated by multiplying a person's heart rate by their systolic blood pressure — is linked to a higher likelihood of having diabetic retinopathy (eye disease caused by diabetes) in people with type 2 diabetes. The study analyzed data from 1,316 hospitalized diabetes patients, about one-third of whom had diabetic retinopathy. After accounting for many other health factors, higher RPP values were consistently associated with greater odds of having diabetic retinopathy, and this relationship appeared to be linear — meaning risk increased steadily as RPP increased rather than jumping at a specific threshold.
The researchers used these findings to build a clinical tool called a nomogram — a type of scoring chart — that combines RPP with three other factors (how long someone has had diabetes, whether they use insulin, and their HbA1c level, which reflects blood sugar control over time) to estimate the probability that a patient has diabetic retinopathy. The nomogram showed acceptable accuracy (AUC of 0.732) and performed consistently when tested using statistical validation methods, suggesting it could be useful in clinical settings for identifying patients who may need further eye examination.
This research suggests that RPP, which is easy and inexpensive to measure during a routine clinical visit using only a blood pressure cuff and pulse measurement, may provide useful information about diabetes-related eye disease risk beyond traditional risk factors. If validated in future prospective studies, such a tool could help clinicians more efficiently identify type 2 diabetes patients who are at higher risk for diabetic retinopathy and may benefit from prompt ophthalmologic screening.
Huang S, Zhang C, Wang L, Zheng R, Sun X, Li J, et al.. (2026). Association of rate-pressure product with diabetic retinopathy in patients with type 2 diabetes mellitus: development and internal validation of a nomogram for diabetic retinopathy identification.. Endocrine. https://doi.org/10.1007/s12020-026-04710-8