Could waiting a little too long to treat high blood sugar lead to serious health problems later?
This simple question from a patient—who was also a nurse—sparked nearly ten years of research that may change how we treat and understand diabetes in the United States.
Dr. Neda Laiteerapong, a professor at the University of Chicago, was still a medical fellow when the patient asked, “Did I harm myself by waiting?” The woman had been living with high blood sugar for three years but hadn’t started treatment. Laiteerapong wanted to say “yes,” but she didn’t have the proof.
That question stayed with her. Over the years, it led to the creation of a major research tool: a model that shows how diabetes progresses and what happens if treatment is delayed.
The model is called DOMUS, short for Multiethnic Type 2 Diabetes Outcomes Model for the U.S. It was built using real medical data from 129,000 patients over a 12-year period and recently published in the journal Diabetes Care.
DOMUS stands out because it includes a diverse group of patients, unlike older models that were based mostly on white patients in the UK. This new model tracks how diabetes affects different groups of people in the US—men and women, people from different races, and various income levels.
It can predict 14 possible health problems that people with diabetes may face over about 15 years. These include heart attacks, kidney failure, amputations, and even depression and dementia.
The model looks at how risk factors like blood sugar levels (measured by A1C), weight, and cholesterol change over time. One key finding is that early treatment really matters.
The data showed that blood sugar levels during the first year after diagnosis help predict future health issues. In other words, even a short delay in starting treatment can have long-term effects.
This is important because both patients and doctors sometimes choose to wait. A patient might not feel ready to start medicine. A doctor might think it’s okay to watch and wait if the blood sugar is only slightly high. But the model suggests that this delay could raise the risk of serious problems years later.
Beyond helping individual patients, DOMUS has broader uses. It can help researchers, insurance companies, and government agencies understand which treatments work best and whether they are worth the cost. Since it’s not always possible to run long, expensive studies with real patients, models like DOMUS help fill the gap.
Dr. Laiteerapong and her team are continuing to improve the model. They’re testing it with other sets of patient data to make sure it works well in different situations. They’re also studying how early control of blood sugar may have a lasting effect, and how diabetes impacts different racial and ethnic groups.
Ultimately, DOMUS could help guide decisions at many levels—from what treatments doctors recommend to what programs health officials fund. And it all started with one thoughtful question from a patient.
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