Table 2.
Comparison of algorithms using electronic medical record data for identification of patients with type 2 diabetes
| |
EMR elements |
||||
|---|---|---|---|---|---|
| Reference | Billing/Diagnostic codes | Laboratory results 1 | Medications | Timeframe | Diabetes onset |
| [23] |
≥ 1 short-stay hospital, skilled nursing facility, or home health agency claim or ≥ 2 physician/supplier claims with diabetes diagnosis |
-- |
-- |
1 – 2 year identification period |
-- |
| [24] |
1 hospital discharge abstract or 2 physician services claims showing diabetes |
-- |
-- |
2 year period |
-- |
| [19] |
250.X0, 250.X2, 357.2, 362.0X, 583.81 |
≥ 1 high HbA1c or random glucose or ≥ 2 random glucose tests |
Metformin, sulfonylurea, or insulin |
-- |
-- |
| [25] |
250.X0, 250.X2, or 362.XX (no insulin) |
≥ 1 high HbA1c or ≥ 2 high fasting or random glucose tests |
-- |
Diagnosis ≥ 30 days after first office visit |
First appearance in problem list |
| [26] |
On problem list (coded or free text) ≥ 2 times in 2 years |
≥ 2 high fasting glucose tests in 1 year or any high HbA1c2 |
Hypoglycemic medications |
-- |
-- |
| [27] |
250.X |
High HbA1c, fasting, or random glucose3 |
Number unique anti-diabetes medications |
-- |
-- |
| [28] |
≥ 2 250.X0 or 250.X2 |
High HbA1c or fasting glucose test |
Insulin or oral hypoglycemic agents except metformin |
Surveillance in real time |
-- |
| [29] |
No type 1 code, ≥ 2 type 2 codes |
Abnormal glucose or HbA1c |
Type 2 diabetes medications |
-- |
-- |
| Current Study | ≥ 1 250.X0 or 250.X2, ≥ 1 year before any type 1 code | ≥ 2 high HbA1c or glucose test and ≥ 1 normal HbA1c or glucose test | Excluded for diabetes medication > 30 days before diagnosis | Normal and abnormal labs within 3 years | Earliest of first diagnosis or second high lab |
HbA1c, glycated hemoglobin.
1Laboratory values coincide with American Diabetes Association guidelines (HbA1c ≥ 6.5%, fasting blood glucose ≥ 126 mg/dl, random blood glucose ≥ 200 mg/dl) [20] unless otherwise specified.
2Fasting blood glucose > 7 mmol/L, HbA1c ≥ 7%.
3HbA1c > 6%, fasting or random glucose > 110 mg/dl.