Case complexity and clinical outcome in diabetes mellitus - A prospective study using the INTERMED

The aim of this study was to assess a population of patients with diabetes mellitus by means of the INTERMED, a classification system for case complex ity integrating biological, psychosocial and health care related aspects of disease. The main hypothesis was that the INTERMED would identify distinct clusters of patients with different degrees of case complexity and differe nt clinical outcomes. Patients (n=61) referred to a tertiary reference care centre were evaluated with the INTERMED and followed 9 months for HbA1c va lues and 6 months for health care utilisation. Cluster analysis revealed tw o clusters: cluster 1 (62%) consisting of complex patients with high INTERM ED scores and cluster 2 (38%) consisting of less complex patients with lowe r INTERMED. Cluster 1 patients showed significantly higher HbA1c values a n d a tendency for increased health care utilisation. Total INTERMED scores w ere significantly related to HbA1c and explained 21% of its variance. In co nclusion, different clusters of patients with different degrees of case com plexity were identified by the INTERMED, allowing the detection of highly c omplex patients at risk for poor diabetes control. The INTERMED therefore p rovides an objective basis for clinical and scientific progress in diabetes mellitus. Ongoing intervention studies will have to confirm these prelimin ary data and to evaluate if management strategies based on the INTERMED pro files will improve outcomes.