Diabetes Complications Severity Index (DCSI)—Update and ICD-10 translation

Glasheen, William P.; Renda, Andrew; Dong, Yanting

doi:10.1016/j.jdiacomp.2017.02.018

Cited by 313 publications

(337 citation statements)

References 7 publications

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“…commercial insurance, Medicare and Medicaid), and geographic location by state were captured during the 365 days before treatment intensification. The Diabetes Complication Severity Index (DCSI) was calculated based on diagnoses codes captured during the 365‐day baseline period …”

Section: Methodsmentioning

confidence: 99%

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Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Kim

Unni

Brixner

et al. 2019

Diabetes Obesity Metabolism

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Aims To identify change in glycated haemoglobin (HbA1c) for 1 year after treatment intensification in patients with HbA1c >53 mmol/mol (7.0%) while on two classes of oral antidiabetic drugs (OADs). Material and methods A retrospective cohort study was conducted using a regional health plan claims database for the period January 1, 2010 to March 31, 2017. Patients with type 2 diabetes (T2DM) whose treatment was intensified with insulin, a glucagon‐like peptide‐1 receptor agonist or a third OAD within 365 days of having HbA1c ≥53 mmol/mol (7.0%) on two OADs were included. The HbA1c trajectory for 1 year after intensification was estimated using a mixed‐effects regression model. Results The analysis included 1226 patients with a mean ± SD HbA1c at treatment intensification of 74.2 ± 18.7 mmol/mol (8.93 ± 1.7%). HbA1c was higher in the insulin group (74.2 mmol/mol) than in the non‐insulin group (70.6 mmol/mol), as was the HbA1c decrease ( P < 0.01) over the 1‐year follow‐up, particularly in patients with baseline HbA1c >9%. After intensification, insulin‐ and non‐insulin‐treated patients achieved an average change by month in HbA1c of −4.7 mmol/mol and −2.6 mmol/mol points, respectively. The analysis predicted HbA1c to be the lowest at 6 to 10 months post intensification, depending on intensification treatment and HbA1c at intensification; however, on average, HbA1c remained above 64.0 mmol/mol (8.0%). Conclusion In patients with T2DM, intensification following an HbA1c value ≥53 mmol/mol (7.0%) while on two OADs was associated with a significant improvement in glycaemic control. Patients intensified with insulin had a higher baseline HbA1c but greater HbA1c reduction than those intensified with a non‐insulin agent. However, HbA1c remained above 64 mmol/mol (8.0%) overall. Additional opportunity exists to further intensify therapy to improve glycaemic control.

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Section: Methodsmentioning

confidence: 99%

“…The Diabetes Complication Severity Index (DCSI) was calculated based on diagnoses codes captured during the 365-day baseline period. 16…”

Section: Study Cohortmentioning

confidence: 99%

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Kim

Unni

Brixner

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…One study was excluded [18] after full-text review as it represented a duplication of a previously developed diabetes severity measure (already included in our review) [19] by updating International Classification of Diseases (ICD) codes from ICD-9 to ICD-10. Consistent with our eligibility criteria, we retained the paper describing the original severity measure.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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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.

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“…For each woman with type 1 or type 2 diabetes, a Diabetes Complications Severity Index (DCSI) score was calculated. The DCSI is an ICD‐10 based scoring system that assigns zero (no complications), one (no severe complications, but at least one mild complication) or two (one or more severe complications) points based on the presence of any of seven diabetic complications, namely, cardiovascular, cerebrovascular or metabolic complications or nephropathy, neuropathy, peripheral vascular disease or retinopathy …”

Section: Methodsmentioning

confidence: 99%

“…The DCSI is an ICD-10 based scoring system that assigns zero (no complications), one (no severe complications, but at least one mild complication) or two (one or more severe complications) points based on the presence of any of seven diabetic complications, namely, cardiovascular, cerebrovascular or metabolic complications or nephropathy, neuropathy, peripheral vascular disease or retinopathy. 18 Women were categorized as undergoing iatrogenic delivery if codes were present for labor induction or pre-labor cesarean delivery. Labor induction was identified based on a Canadian Classification of Health Interventions (CCI) code.…”

Section: Key Messagementioning

confidence: 99%

Timing of delivery in women with diabetes: A population‐based study

Metcalfe

Hutcheon

Lyons

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week‐specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population‐based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week‐specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age‐specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks’ gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks’ gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks’ gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks’ gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal‐fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks’ gestation may optimize neonatal outcomes among women with diabetes.

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Diabetes Complications Severity Index (DCSI)—Update and ICD-10 translation

Abstract: While the performance of the tool with purely ICD-10 data has yet to be evaluated, this updated tool makes assessment of diabetes patient severity and complications possible in the interim.

Cited by 313 publications

References 7 publications

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

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

Timing of delivery in women with diabetes: A population‐based study

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