Issue 174 Item 4 Nomogram Predicts Disability In Adults With Diabetes

Primary care physicians use a new one-page nomogram to easily predict the risk of physical disability for adults with diabetes with this new Clinical assessment tool.

Before developing the clinical assessment tool, Dr. Radosevich and his colleagues evaluated predictors of functional disability in 1,818 patients with diabetes treated in 13 large medical group practices that were generally run by family physicians and internists. All were functionally independent at enrollment.

Not a lot of studies have evaluated the effect of diabetes mellitus on physical disability, noted Dr. Radosevich, of the University of Minnesota, Minneapolis. Researchers typically assess other complications of diabetes.

Annual incidence of functional disability based on the 10-item Physical Functioning Scale score was 7% for the patients aged 31-64 years and 18% for those aged 65 and older. Dr. Radosevich and his colleagues analyzed the data to identify predictors of high-risk outcomes at 12 months from baseline characteristics in those two groups.

In the younger group, an increased risk of functional disability was associated with chronic obstructive pulmonary disease (odds ratio 2.85), angina (odds ratio 2.74), low education attainment (odds ratio 2.23), and upper-extremity arthritis (odds ratio 1.84). A decreased incidence of functional disability was associated with higher baseline functioning (odds ratio 0.93), white race (odds ratio 0.43), a recent eye examination (odds ratio 0.50), and visiting a diabetes educator (odds ratio 0.40).

In the older group, an increased risk of functional disability was associated with advanced age (odds ratio 1.27), lower-extremity arthritis (odds ratio 1.64), and chronic obstructive pulmonary disease (odds ratio 2.46). A decreased incidence of functional disability was associated with higher baseline functioning (odds ratio 0.59) and recent monitoring for low-density lipoprotein level (odds ratio 0.54).

These predictors were incorporated into the nomogram. Each risk factor was assigned a point value, with the point total indicating the percent risk of functional disability in the next 12 months.

Many of the risk factors are modifiable, Dr. Radosevich noted. The nomogram features “real simple parameters you can identify,” he said. “It’s kind of crude now—it’s paper and pencil—but in the future it may be computer based.” Plans call for implementing the nomogram in primary care practices to compare its predictions with actual outcomes.

The nomogram is available from Clese Erikson of the American Medical Group Association at 703-838-0033 or cerikson@amga.org.

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DID YOU KNOW: Target Heart Rates May Predict CVD and Death in Men With Diabetes: Target heart rate following exercise may serve as an early indicator of cardiovascular disease (CVD) and all-cause death in men with diabetes. Diabetes Care July 2003