A patient’s simple question led to the creation of DOMUS, a model revealing how early diabetes treatment can significantly impact long-term health outcomes. This breakthrough has powerful implications for patients, clinicians and policymakers.
A question from an experienced nurse, living with slightly elevated blood sugars for three years, sparked nearly a decade of intensive research that has now resulted in a revolutionary model poised to transform diabetes care in the United States.
Neda Laiteerapong, a professor of medicine and chief of general internal medicine at the University of Chicago, faced a dilemma when the patient, who had not started treatment, asked, “Did I harm myself by waiting?”
“I wanted to say, ‘Yes, absolutely,’ but I didn’t have any evidence to support that,” Laiteerapong said in a news release.
This question ignited a pursuit to quantify the costs and benefits of early diabetes treatment.
Laiteerapong, using patient data from Kaiser Permanente, unveiled the Multiethnic Type 2 Diabetes Outcomes Model for the U.S. (DOMUS).
Published in Diabetes Care, DOMUS can predict 14 complications over 15 years and track changes in weight, cholesterol, A1C levels, among other risk factors. Notably, it includes traditional complications such as heart attacks and kidney failure, and also newer concerns such as depression and dementia.
Compared to other models like the UKPDS, which is based on 30 years of data from around 5,000 UK patients, DOMUS utilizes data from a more diverse U.S. cohort — 129,000 patients across 12 years.
“We wanted to build a model that represented the people we actually treat in the US — a socioeconomically and racially diverse population,” Laiteerapong added.
The findings confirm the importance of early diabetes treatment.
“First-year A1C did, in fact, help predict long-term complications. So yes, those early months matter,” added Laiteerapong.
This insight challenges the “wait and see” approach often taken by patients and health care providers in the early stages of diabetes. Even modest delays in treatment can have profound, lasting effects.
Beyond patient care, DOMUS could reshape public health strategies.
“Historically, when we ask policy questions about diabetes, we often can’t do it using real people in real time,” Laiteerapong added. “We have to estimate or simulate the outcomes using mathematical models. These models help us figure out the likelihood of something leading to a potential health outcome and whether an intervention is worth funding.”
The team is now working on external validation and exploring racial and ethnic disparities in outcomes, in addition to the long-term benefits of early A1C control.
“DOMUS can be used by insurers, policymakers, and public health agencies to guide decisions — especially when clinical trials take too long or aren’t feasible,” concluded Laiteerapong, indicating the vast potential for future collaborations and applications.
Source: The University of Chicago Division of the Biological Sciences