Background
Methods
Defining microvascular and macrovascular disease stages
Revisions to the existing vascular staging instrument
Vascular stage & broad classification of stages
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Detailed classification item | Measures (Australian Refined Diagnosis Related Group code version 5.0* or clinical reference range) | |
1
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Diagnosis of type 2 diabetes
| Doctor diagnosis confirmed by a medical chart audit or a fasting blood glucose level ≥ 7 mmol/L† or 2-hour glucose tolerance test result of blood glucose level ≥ 11.1 mmol/L †[10] or a hospital admission for diabetes |
With no evidence of microvascular or macrovascular risk factors (but may be obese or report current tobacco smoking)
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Albumin creatinine ratio (ACR) within normal range | ACR of 0–2.5 mg/mmol for men and 0–3.5 mg/mmol for women‡
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Normal high density lipoprotein cholesterol (HDLC) | > 1.0 mmol/L§
| |
Normal triglycerides | < 1.5 mmol/L§
| |
Not hypertensive | Not hospitalised for hypertension (DRG code F67A or F67B), or blood pressure < 140/90 mmHg ||
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No evidence of retinopathy | Not hospitalised for retinal procedures and vascular disorders of the eye (DRG code C03Z or C16Z) | |
Peripheral sensation normal and no evidence of claudication | Not hospitalised for DRG code F65A or F65B | |
No cardiac disease | Not hospitalised for DRG code A05Z, F12Z, F14A, F14B, F62Z, F62B, F70A, F70B, F62A, F14C, F15Z, F16Z, F17Z, F18Z, F19Z, F10Z, F41A, F41B, F60A, F60B or F60C | |
2
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Screen-detected microvascular comorbidities and/or risk factors for macrovascular disease
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Microalbuminuria | ACR 2.6–25 mg/mmol for men and 3.6-35 mg/mmol for women‡
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Reduced HDLC | ≤ 1.0 mmol/L§
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Elevated triglycerides | ≥ 1.5 mmol/L§
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Hypertension | Hospitalised for DRG code F67A or F67B, or systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg||
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3
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Moderate microvascular and/or macrovascular comorbidities
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Macroalbuminuria | ACR > 25 mmol/L for men and > 35 mmol/L for women‡
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History of coronary artery bypass graft or angioplasty | F05A, F05B, F06A, F06B | |
History of carotid artery disease | F66A, F66B | |
History of or hospitalised for angina | F72A, F72B | |
History of claudication or peripheral vascular disease | F65A, F65B | |
4
|
Late-stage diabetes macrovascular and/or microvascular comorbidities
| |
Amputation of lower limb | F11A, F11B, F13Z, I07Z, I14Z | |
Present or history of gangrene of the lower limb | J13A, J13B, J64A, J64B | |
History of stroke with residual deficit | B69A, B69B, B70A, B70B, B70C, B70D | |
History of or hospitalised for cardiac failure | A05Z, F12Z, F14A, F14B, F62A, F62B, F70A, F70B | |
History of myocardial infarction | F14C, F15Z, F16Z, F17Z, F18Z, F19Z, F10Z, F41A, F41B, F60A, F60B, F60C | |
Proliferative retinopathy and both eyes: only able to perceive light or hand movement or count fingers, or unable to perceive light | C03Z, C16Z | |
Present or history of osteomyelitis or ulcer of the foot or charcot joint | I64A, I64B | |
Bacterial soft tissue infection of the foot | J12A, J12B, J12C, | |
History of painful neuropathy or autonomic neuropathy other than erectile impotence | K01Z | |
History of end-stage renal failure | L60A, L60B, L60C | |
History of dialysis | L61Z | |
History of renal transplant | A09A, A09B |
Mapping objective measures to detailed classification items
Data sources
Data linkage
Instrument application
Analysis
Results
Mean age (years) (SD) (range) | 48 (12.5) (17 – 85) |
Proportion female | 58 % |
Mean body mass index (kg/m2)* (n = 376) (SD) (range) | 32 (6.4) (16.2 – 52.4) |
Waist circumference men <102 cm*
| 33 % |
Waist circumference women <88 cm*
| 4 % |
Fasting blood glucose level < 5.5 mmol/L† (n = 373) | 3.5 % |
Blood pressure <140/90 mmHg‡ (n = 378) | 51.8 % |
Macroalbuminuria† (n = 356) | 34.5 % |