Linzer et al reported the Diabetes Severity Measure (DMSEV) to describe the severity of illness in Type 2 diabetes mellitus. The authors are from the University of Wisconsin in Madison, Edith Nourse Rogers Memorial Veterans Hospital (Bedford, Massachusetts), Boston University, University of South Maine, University of California Irvine, Regenstrief Institute and Roudebush VAMC in Indianapolis.
Patient selection: Type 2 diabetes mellitus
Parameters:
(1) eye disease - blurred vision, cataracts, difficult reading, referral to ophthalmologist
(2) foot disease
(3) autonomic neuropathy
(4) peripheral neuropathy
(5) cerebrovascular accident (atherosclerosis)
(6) transient ischemic attack, TIA (atherosclerosis) - weakness on one side of body, speaking difficulty, mouth drooping, etc with return to normal within a day
(7) myocardial infarction (atherosclerosis)
(8) chest pain (atherosclerosis)
(9) peripheral vascular disease, PVD (atherosclerosis) - leg cramps or pain while walking with relief after rest
|
Parameter
|
Finding
|
Points
|
|
eye disease
|
none
|
0
|
|
|
retinopathy or problem
|
1
|
|
|
requires laser therapy
|
2
|
|
foot disease
|
none
|
0
|
|
|
ulcers or infections of toes
|
1
|
|
|
gangrene of toes
|
2
|
|
|
amputation of toes or feet
|
3
|
|
autonomic neuropathy
|
none
|
0
|
|
|
nocturnal diarrhea
|
1
|
|
peripheral neuropathy
|
none
|
0
|
|
|
numbness and/or tingling in legs
|
1
|
|
cerebrovascular accident
|
none
|
0
|
|
|
stroke ever
|
1
|
|
|
stroke with permanent effects
|
2
|
|
TIA
|
none
|
0
|
|
|
ever
|
1
|
|
myocardial infarction
|
none
|
0
|
|
|
ever
|
1
|
|
|
within past year
|
3
|
|
chest pain
|
none
|
0
|
|
|
once per month
|
1
|
|
|
1 to 3 times per week
|
2
|
|
|
>= 1 times per day
|
3
|
|
peripheral vascular disease
|
none
|
0
|
|
|
claudication if walk > 1 block
|
1
|
|
|
claudication if walk < 1 block
|
2
|
where:
• Renal disease was not included because of the low prevalence in the study population but could be added.
total DMSEV score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the greater the diabetes disease severity.
|
DMSEV
|
Severity
|
|
0
|
very low
|
|
1 or 2
|
low
|
|
3 to 6
|
medium
|
|
7 to 11
|
high
|
|
>= 12
|
very high
|
