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There's a new risk calculator in town, but it's not your parents'Framingham Risk Equation.
Compared with other health-risk predictors, the Web-based Diabetes PersonalHealth Decisions (Diabetes PHD) tool is considerably more sophisticated, saysDavid M. Eddy, MD, PhD, director of the Archimedes Project at KaiserPermanente.
Archimedes is the mathematical model that powers Diabetes PHD withcalculations that factor in basic anatomy, physiology, and other biologicalvariables. Partnering with Archimedes' creators, the American DiabetesAssociation (ADA) built Diabetes PHD to simulate the biology underlyingdiabetes as well as factors such as comorbidity risks, medications, andtreatments.
"We used as a guide the basic information that a primary carephysician would know about and care about," Eddy says.
Any patient or clinician can use the free online program. After enteringpersonal health information such as age, sex, weight, family medical history,medications, blood lipid values, and retinal problems, the user will receive aprofile detailing his or her risks of diabetes and its complications. Thereport also provides an accurate picture of how the individual can alter thoserisks with actions such as losing weight, quitting smoking, or reducing bloodpressure or cholesterol levels.
"It is primarily designed as a patient-awareness tool, but we believesome motivated physicians will use it to look at individual patients' risksand hopefully guide them to treatment decisions based on what they see,"says Matt Petersen, ADA's director of information resources.
Until recently, models in clinical medicine have been too simplistic tocapture the details clinicians need, Eddy says, taking into account far fewerclinically important variables.
"[Diabetes PHD] is quite a bit more clinically realistic. That's alsowhat enables it to be so accurate," he says.
The accuracy has been validated, Eddy says, by testing Diabetes PHD amongthe tens of thousands of people who have participated in more than two dozenof the most important clinical trials related to diabetes and itscomplications.
The program can be used as a preventive tool by those who do not yet havediabetes but may have impaired fasting glucose, impaired glucose tolerance,prediabetes, or metabolic syndrome. The system's own statement of limitationsmakes clear that Diabetes PHD is not intended to replace a clinician'sjudgment or to be predictive or useful for everyone, nor does it provide theonly appropriate analysis of a medical problem.
"The main value is it provides answers to questions that are of greatconcern to patients and physicians by taking what would otherwise be aqualitative question and giving a quantitative answer," Eddy says."A patient might ask, `What difference will it make if I lose 10 lb?' Hecan go on Diabetes PHD and see." 
Footnotes
Diabetes PHD provides risk profiles online in real time—usuallywithin minutes—or users can request results via email. During periods oftypical demand, calculations that in the past would take tens of hours toprocess are made in a fraction of the time, thanks to distributed computing.But don't get frustrated if it takes a little longer. Matt Petersen of theAmerican Diabetes Association expects an enthusiastic response as people learnabout the tool. Peak demand could exceed capacity. You can simply read ane-mailed report at a more convenient time or use those extra minutes as anopportunity for additional patient education.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
