Severity domains for quantifying the severity of Type 2 diabetes using primary care data and linked hospitalisation records from England

Aims: Despite the increasing prevalence of Type 2 diabetes, which
presents a significant burden on healthcare resources, there is no
agreed validated UK measure to infer Type 2 diabetes severity from
electronic health records (EHRs). This study aimed to identify
important clinical severity domains, recorded in EHRs, which
could be used to quantify the severity of Type 2 diabetes.
Methods: Data from the Clinical Practice Research Datalink
(CPRD) and hospitalisation records for people with Type 2
diabetes, registered with linked English general practices, to be
used to develop a clinical decision algorithm to grade diabetes
severity between 2006 and 2016. At this stage of the study, we
have identified clinically relevant severity domains (main risk
factors for adverse outcomes) to be incorporated in the severity
algorithm.
Results: The main severity domains for Type 2 diabetes identified
through a systematic review and expert opinion include age,
diabetes duration, HbA1c, hypoglycaemia, microvascular complications,
cardiovascular (CV) disease (heart failure, coronary heart
disease, revascularisation interventions), cerebrovascular disease,
renal disease, patterns of prescribed antidiabetic and cardiovascular
treatments, hospital admissions (any-cause, diabetes-related
and CV disease-related admissions).
Summary: All identified severity domains, recorded in routinely
collected real-world EHRs, are clinically relevant in our work to
define the severity of Type 2 diabetes. This first step forms a platform
on which to develop the severity tool, which will be informative to
practitioners, could stratify clinical management of people with
Type 2 diabetes, support commissioning and public health programmes
and inform the methodology of measuring the severity of
other chronic conditions managed in primary care.