University of Chicago: New model shows how treating diabetes early makes a difference

Could slightly elevated blood sugar levels lead to serious health problems in the future? A single patient's question sparked nearly a decade of research leading to the development of a landmark model that could shape how clinicians and researchers understand and manage diabetes across the US.

When she was a fellow in clinic, Neda Laiteerapong, MD, MS, Professor of Medicine and Chief of General Internal Medicine at the University of Chicago, had a patient—an experienced nurse—who asked a deceptively simple question. She had been living with elevated blood sugars for about three years and had not yet started treatment. "Did I harm myself by waiting?" she asked.

At the time, Laiteerapong did not have an answer. "I wanted to say, 'Yes, absolutely,' but I didn't have any evidence to support that," she recalls. "The challenge with diabetes is that the benefits of treatment—like controlling blood sugar, blood pressure, cholesterol, weight, or quitting smoking—often don't show up until many years later. For example, controlling blood sugar today may prevent complications 10 or even 20 years from now. But not everyone with diabetes develops complications, so there's a lot of uncertainty."

That unanswered question led Laiteerapong on a mission to understand just how much treatment matters, what it costs to delay treatment in the early stages of diabetes, and how much each treatment can benefit a patient's health over time. Using real-world patient data from Kaiser Permanente, Laiteerapong and her team have now created a model to predict not only the traditional complications of diabetes, such as heart attacks, kidney failure, and amputations, but also outcomes such as depression and dementia, which have begun to receive more attention in recent years.