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Table 2 Comparison of algorithms using electronic medical record data for identification of patients with type 2 diabetes

From: A novel method for studying the temporal relationship between type 2 diabetes mellitus and cancer using the electronic medical record

 

EMR elements

Reference

Billing/Diagnostic codes

Laboratory results1

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

  1. HbA1c, glycated hemoglobin.
  2. 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.
  3. 2Fasting blood glucose > 7 mmol/L, HbA1c ≥ 7%.
  4. 3HbA1c > 6%, fasting or random glucose > 110 mg/dl.