Severity of Diabetes Does Not Predict Usual Complications

If you have diabetes, you may also have problems with blood pressure, vision, kidneys, and your oral health. In all likelihood, your doctor already has cautioned you that having diabetes increases your risk for developing a whole range of other chronic health conditions such as heart disease, and kidney problems

There is some good news. Researchers found that the severity of your diabetes does not appear to be linked with the number of complications you may develop, says Adeba Mohammad, a researcher and medical student at Western University of Health Sciences in Pomona, California.

These findings were presented by Dr. Mohammad at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease.1

"We did not find a meaningful association between the severity of diabetes and the number of associated conditions," Mohammad tells EndocrineWeb, which was unexpected. As it turns out, the findings reflected just the opposite of what the researchers expected they would find.

New health score card for predicting conditions that commonly occur in people with diabetes.

A Closer Look at the Study

The study gathered data on 160 women, and men—all with type 2 diabetes. The average age was 56 years. 

Mohammad and her colleagues looked at nine possible conditions often related to diabetes, including:

  • Hemoglobin A1C (a measure to follow blood sugars over 2-3 months)
  • LDL (low-density lipoprotein), ''bad'' cholesterol
  • Blood pressure 
  • Chronic kidney disease stage
  • Retinal health
  • Periodontal health
  • Foot Health
  • Depression screening
  • Body mass index (BMI)

The conditions were rated on a level of severity using a health scorecard—the Diabetes Cross-Disciplinary Index—DXDI. The DXDI rates conditions from 1 (good control or absence of the condition) to 5 (poor control or advanced disease).

A category of ''low'' was assigned in the conditions that received a rating of none to two conditions, and a "high" was defined as those conditions receiving a DxDl score of three or more.

The researchers found, for instance, that someone with a very high A1C tended to have the same number of associated conditions as someone with an A1C at ideal levels.

According to the researchers, most people with diabetes have two or more chronic health conditions, such as high blood pressure. Preventive care, such as encouraging people to lose weight, stop smoking and control blood pressure, are aimed at reducing the risk or delaying the onset of complications.

A Role for the DXDI Index

The index or ''scorecard'' used in the study, Mohammad says, may offer a motivating insight for people with diabetes to keep tabs on the possibility of developing conditions that commonly occur and makes it easier for patients to keep diseases that may develop under control.  The researchers have used the health scorecard with their patients who have provided positive feedback, she says.

Andrew Pumerantz, DO, FACP, executive director of the Western Diabetes Institute at Western University of Health Sciences in Pomona, California, a study co-author, who invented the DXDI. The researchers hope the scorecard will become adopted by other diabetes clinics and endocrinology practices so it becomes more widely used.

The index is colorful. On the horizontal axis are the conditions. For instance, body mass index, or BMI, is rated from 1 to 5, with 1 in a green square and 5 in a red square. Green is a BMI in a healthy range, from 18.5 to 24.9. If the BMI is termed very obese, it is a 5, or red square.

By looking at the index, patients can see what they have to do to work up to the green or ideal square, Mohammad says. For blood pressure control, under 130/80 would be in the number 1 or green box; 160/110 or higher would be the red ''danger'' box. It graphically demonstrates that ''keeping all [conditions or risk factors] under control helps," Mohammad says.

A method to identify conditions associated with type 2 diabetesReprinted with permission, AS Pumerantz, DO, copyright 2012 Western University, Pomona, CA.

Evaluating the Usefulness of the DXDI as a Predictive Tool

The findings are not surprising, says Zachary Bloomgarden, MD, clinical professor of medicine at Mount Sinai School of Medicine and assistant attending at Mount Sinai Hospital. He reviewed the study.

"It is a clinical index that appears to correlate with well-known risk factors [associated with diabetes]," he says of the DXDI. The study and results do illustrate the complexity of diabetes, he says, and the fact that so many other conditions are related to it.

There are many ways to communicate the related risks, he says, and he applauds whatever works to get the message across to those with diabetes.

"The visual tool is motivating for both patients and healthcare providers," says J. Michael Gonzalez-Campoy, MD, PhD, medical director and CEO at the Minnesota Center for Obesity, Metabolism, and Endocrinology in Eagan, Minnesota, who was invited to review the study for EndocrineWeb.

"This tool easily lets us know how aggressively we [doctors] need to be in intervening with patient care," he says.

While it is not yet widely used, he predicts it will be adopted quickly. It still requires a team approach with input from ophthalmologists, dentists, and mental health professionals.

Neither Ms. Mohammad nor Dr. Gonzalez-Campoy had any conflicts to declare. Dr. Bloomgarden reports consultant work for Sanofi, Astra Zeneca, Janssen, Merck, Intarcia and Novartis; and is on the speaker's bureau for Amgen, Merck, AstraZeneca, Janssen, and stock in Allergan, Zimmer Biomet, and Novartis.


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