Zghebi, S, Panagioti, M, Rutter, M, Ashcroft, D, van Marwijk, H, Salisbury, C, Chew-Graham, CA, Buchan, I, Qureshi, N, Peek, N, Mallen, CD ORCID: 0000-0002-2677-1028, Mamas, M ORCID: 0000-0001-9241-8890 and Kontopantelis, E (2019) Assessing the Severity of Type 2 Diabetes Using Clinical Data Based Measures: a Systematic Review. Diabetic Medicine.

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Abstract

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.

Item Type: Article
Additional Information: The final published version of this accepted manuscript is available online at https://doi.org/10.1111/dme.13905
Uncontrolled Keywords: diabetes, severity, type 2 diabetes, electronic health records
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC660 Diabetes
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 04 Jan 2019 15:22
Last Modified: 28 Feb 2019 10:12
URI: http://eprints.keele.ac.uk/id/eprint/5631

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