ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
This article is part of the Research TopicEnhancing the Health of Vulnerable Populations Through Integrated Biosocial ApproachesView all 5 articles
Exploring core and sentinel symptoms in elderly patients with Type 2 diabetes through network analysis and the Apriori algorithm
Provisionally accepted
Tingting Tan1
Chongyao Yang1Qingqing Wang1Cong Xu1Sijing Wang2
Bingbing Xiao1Jing Zhao1Huan He1Miaoqin Wang1*- 1Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- 2West China Fourth Hospital Sichuan University, Chengdu, China
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Objective: To construct the symptom network of elderly patients with type 2 diabetes mellitus (T2DM) and perform association rule analysis for each symptom cluster, identify core symptoms, and explore the sentinel symptoms, to provide references for accurate and efficient symptom management. Methods: Convenience sampling was employed. Eligible elderly patients with T2DM were enrolled from the department of endocrinology, affiliated hospital of North Sichuan Medical College, Nanchong City, from March 2024 to July 2024, with data collected using the Chinese Version of Diabetes Symptom Checklist-Revised (DSC-R). The correlation was analyzed using the Apriori algorithm model to identify the sentinel symptoms of each symptom cluster, and the core symptom was identified based on the network analysis method. Results: The most prevalent symptoms were thirst and dry mouth (71.69%), general fatigue (70.78%), and frothy urine (69.58%). Regarding symptom burden severity, general fatigue (2.48 ± 1.89), asthenia (2.42 ± 1.94), and insomnia (2.39 ± 1.98) had the highest scores. Sentinel symptoms, including excessive sleepiness, limb numbness, swelling of the limbs, and polydipsia, are characteristic manifestations of distinct symptom clusters: psychological cognition symptom cluster, peripheral nerve symptom cluster, nephropathy symptom cluster, and hyperglycemia symptom cluster. At the global level, general fatigue (rs = 1.207) emerged as the core symptom. This is a provisional file, not the final typeset article Conclusion: This study identifies general fatigue as the core symptom, with excessive sleepiness, limb numbness, limb swelling, and polydipsia emerging as sentinel symptoms, within their respective symptom clusters. From the perspective of symptom network analysis and sentinel symptoms, clinical staff can develop accurate and efficient intervention measures to improve the efficiency of symptom management and reduce the burden of symptoms in elderly patients with T2DM.
Keywords: core symptoms3, elderly patients with type 2 diabetes mellitus1, network analysis4, sentinel symptoms2, symptom management5
Received: 20 Oct 2025; Accepted: 06 Feb 2026.
Copyright: © 2026 Tan, Yang, Wang, Xu, Wang, Xiao, Zhao, He and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Miaoqin Wang
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