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Assessing the severity of Type 2 diabetes using clinical data-based measures: a systematic review

Zghebi, S. S.; Panagioti, M.; Rutter, M. K.; Ashcroft, D. M.; van Marwijk, H.; Salisbury, C.; Chew-Graham, C. A.; Buchan, I.; Qureshi, N.; Peek, N.; Mallen, C.; Mamas, M.; Kontopantelis, E.

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S. S. Zghebi

M. Panagioti

M. K. Rutter

D. M. Ashcroft

H. van Marwijk

C. Salisbury

C. A. Chew-Graham

I. Buchan

N. Peek

C. Mallen

M. Mamas

E. Kontopantelis


Aims: To identify and critically appraise measures that use clinical data to grade the severity of Type 2 diabetes.
Methods: We searched MEDLINE, Embase and PubMed between inception and June 2018. Studies reporting on clinical data?based diabetes?specific severity measures in adults with Type 2 diabetes were included. We excluded studies conducted solely in participants with other types of diabetes. After independent screening, the characteristics of the eligible measures including design and severity domains, the clinical utility of developed measures, and the relationship between severity levels and health?related outcomes were assessed.
Results: We identified 6798 studies, of which 17 studies reporting 18 different severity measures (32 314 participants in 17 countries) were included: a diabetes severity index (eight studies, 44%); severity categories (seven studies, 39%); complication count (two studies, 11%); and a severity checklist (one study, 6%). Nearly 89% of the measures included diabetes?related complications and/or glycaemic control indicators. Two of the severity measures were validated in a separate study population. More severe diabetes was associated with increased healthcare costs, poorer cognitive function and significantly greater risks of hospitalization and mortality. The identified measures differed greatly in terms of the included domains. One study reported on the use of a severity measure prospectively.
Conclusions: Health records are suitable for assessment of diabetes severity; however, the clinical uptake of existing measures is limited. The need to advance this research area is fundamental as higher levels of diabetes severity are associated with greater risks of adverse outcomes. Diabetes severity assessment could help identify people requiring targeted and intensive therapies and provide a major benchmark for efficient healthcare services.

Journal Article Type Article
Acceptance Date Dec 21, 2018
Online Publication Date Jan 22, 2019
Publication Date May 10, 2019
Deposit Date Feb 4, 2019
Publicly Available Date Jan 23, 2020
Journal Diabetic Medicine
Print ISSN 0742-3071
Electronic ISSN 1464-5491
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 36
Issue 6
Pages 688-701
Keywords Internal Medicine; Endocrinology, Diabetes and Metabolism; Endocrinology
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