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Study of 11.5 million electronic patient records finds 5.4% of people in the US with diabetes are currently undiagnosed, but identifiable through simple computer searches.

An analysis of 11.5 million electronic patient records in the United States has identified a significant number of people with undiagnosed diabetes, which has implications for care.

The study, by UK and US researchers and published in CMAJ Open, was led by Dr Tim Holt, Nuffield Department of Primary Care Health Sciences, University of Oxford, who commented:

“We were able to identify a substantial number of patients with uncoded diabetes and probable undiagnosed diabetes based on existing biochemical evidence using simple algorithms applied to primary care electronic records.”

Diabetes cost the US $245 billion (£153 billion) in 2012, and according to latest US Centers for Disease Control and Prevention estimates, is undiagnosed in 27.8% of people with the disease. Prompt diagnosis and treatment is important to help prevent health complications from untreated disease.

The study investigated electronic records for 11.5 million patients at more than 9,000 primary care clinics across the US. Researchers looked at diabetes coding in records, analysed biochemical data using an algorithm and measured the quality of diabetes care.  Of the total 1,174,018 people with diabetes, 63,620 (5.4%) had undiagnosed diabetes - this proportion was higher in parts of Arizona, North Dakota, Minnesota, South Carolina and Indiana.

“In some areas of the country, this amounted to 12%–15.9% of the overall diabetes population. Although this is less than the 27.8% believed to have undiagnosed diabetes, these people were immediately identifiable through simple searches of electronic medical records from primary care practices,” write the authors.

Their findings also indicate that patients managed using electronic diabetes registers generally achieve better care quality, according to a wide range of measures. Use of electronic registers is a long established tradition in UK primary care but has taken longer to become part of US practice.

“Wherever electronic diabetes registers are used to support the provision of care, and where blood glucose levels, HbA1c and quality-of-care data are recorded in the same system, it should be possible to identify readily (and at low cost) individuals at risk of their diabetes going undetected and those receiving suboptimal care. This applies across all nations using electronic medical records, including Canada.”

Read the full research paper:

Identification of undiagnosed diabetes and quality of diabetes care in the United States; cross-sectional study of 11.5 million primary care electronic records.
Tim A Holt, Candace L Gunnarsson, Paul A Cload, Susan D Ross.  
CMAJ Open 2014;2(4):E248-E255.


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