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Study Overview : DEDICOM

Projecting the Future Risk of Cardiovascular Complications in Diabetes

This research presents a comprehensive analysis of long-term cardiovascular risk among diabetes patients in Delhi, based on data from the DEDICOM-II community survey.

Using validated global risk engines and real-world clinical data, the study estimates the 10-year risk of major cardiovascular events, including coronary heart disease, stroke, and mortality.

Unlike hospital-based projections, this work reflects a population-level, community-based reality, capturing patients across socio-economic groups and care settings.

It provides a forward-looking view of:

  • Cardiovascular risk burden in diabetes
  • Gaps in preventive care and risk management
  • Scope for mitigating long-term complications
Future Risk

The Problem

The Silent Escalation of Cardiovascular Risk in Diabetes

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Diabetes significantly increases the risk of cardiovascular disease, yet long-term complication risk remains under-assessed in India.

Key challenges include:

  • Limited real-world data on future cardiovascular risk projections
  • High prevalence of uncontrolled risk factors
  • Poor uptake of cardioprotective therapies
  • Lack of integration between risk assessment and routine care
  • Increased vulnerability due to South Asian ethnicity

Despite established global guidelines, risk factor control remains suboptimal, leading to preventable long-term complications.

Objective

Estimating and Understanding Long-Term Cardiovascular Risk

The study aims to:

  • Estimate 10-year cardiovascular risk in known diabetes patients
  • Evaluate risks of:
    • Coronary heart disease (CHD)
    • Stroke
    • Cardiovascular mortality
  • Compare actual risk with:
    • Low-risk scenarios
    • Target-level clinical control
  • Assess the mitigability of risk through improved care

The objective is to provide actionable insights for clinical practice and public health strategy.

Study Design & Methodology

A Community-Based Risk Projection Using Global Models

Study Design and Methodology

The study is based on the DEDICOM-II community survey conducted in Delhi (2018–2020).

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Study Design:

  • Two-stage cluster sampling across 30 geographic clusters
  • House-to-house survey approach
  • Inclusion:
    • Adults aged 35–65 years
    • Known diabetes ≥1 year
  • Sample size:
    • 843 participants
    • 800 with laboratory data

Data Collection Included:

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Risk Assessment Approach:

Cardiovascular risk was estimated using multiple global risk engines:

  • UKPDS (diabetes-specific model)
  • Framingham Risk Score
  • ASCVD Risk Estimator
  • WHO Risk Charts
  • SCORE Project
  • NHS Risk Calculator

This multi-model approach ensures robust, comparative risk projections.

Intervention:

This study is a risk modeling and projection exercise, not a treatment intervention.

It evaluates:

  • Existing risk factor profiles
  • Current treatment patterns
  • Potential reduction in risk under:
  • Optimal clinical control
  • Evidence-based interventions

By studying real-world systems, the research highlights structural inefficiencies and inequities in diabetes care delivery.

Outcome Measures:

    Primary Outcomes

  • 10-year risk of:
    • Coronary heart disease, Stroke, Cardiovascular mortality
  • Secondary Outcomes
    • Risk ratios vs:
      • Low-risk individuals and Target-controlled patients
    • Estimated:
      • Heart age and Life expectancy
    • Prevalence of:
    • Hypertension, Dyslipidemia and Poor glycemic control

Key Findings

High Risk, Low Control, and Significant Scope for Improvement

The study reveals a concerning risk profile:

Elevated Cardiovascular Risk

  • 10-year CHD risk: ~10–16%
  • Stroke risk: ~3.7–5%
  • Cardiovascular mortality risk: ~5%

Risk Amplification

  • Risk levels are 1.5–3 times higher than optimal targets

Impact on Longevity

  • ~16-year increase in “heart age”
  • ~9-year reduction in life expectanc

Poor Risk Factor Control

  • 53.3% with poor glycemic control
  • 61.8% hypertensive
  • 81.5% dyslipidemic

Low Use of Preventive Therapies

  • Aspirin: ~9%
  • Lipid-lowering drugs: ~16%
    • Antihypertensives: ~30%
Key Findings Infographic
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Real-World Impact Infographic

Impact

A High-Risk Future That Is Largely Preventable

The findings highlight a critical gap between risk and care delivery:

  • High burden of preventable cardiovascular disease
  • Inadequate use of evidence-based treatments
  • Poor integration of risk assessment into care pathways

Health System Implications

  • Urgent need for early risk identification
  • Strengthening primary care and screening systems
  • Scaling use of cardioprotective medications
  • Improving long-term disease management strategies

Highlight

Diabetes patients in urban India face up to 3× higher cardiovascular risk—much of which is preventable with better care

Global Significance

Implications for Diabetes Care in LMICs

This study offers critical insights for global health systems

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Demonstrates the importance of risk-based care models

02

Highlights challenges in low-resource and mixed healthcare systems

03

Reinforces need for integrated chronic disease management

04

Supports adoption of predictive analytics in public health

Provides a scalable framework for risk-based intervention planning in diabetes care globally

Why This Study is Globally Relevant
SACMIND Research Team
About The Research Team

Experts in Clinical Epidemiology and Public Health Research

This research was conducted by the team at: Sitaram Bhartia Institute of Science and Research (SBISR), New Delhi

TThe team specializes in:

  • Clinical epidemiology
  • Chronic disease research
  • Community health systems
  • Evidence-based healthcare design
Publication Authority

Published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews (Elsevier 2023)

This is a peer-reviewed, internationally indexed journal, lending strong scientific credibility to the study and its findings.

JMIR Research Protocols Journal
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Turning Risk Insights into Preventive Action

We welcome collaborations with:

  • Research institutions
  • Public health organisations
  • Funding partners
  • Policy-makers

The DEDICOM-II cardiovascular risk study underscores a critical reality—a large proportion of future cardiovascular events in diabetes patients are preventable with timely, evidence-based care.

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