Validation of classification algorithms for childhood diabetes identified from administrative data

Vanderloo, Saskia; Johnson, Jeffrey; Reimer, Kim; McCrea, Patrick; Nuernberger, Kimberly; Krueger, Hans; Aydede, Sema K.; Collet, Jean‐Paul; Amed, Shazhan

doi:10.1111/j.1399-5448.2011.00795.x

Cited by 35 publications

(50 citation statements)

References 20 publications

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“…Caution must be exercised in generalizing these findings to youth with other forms of health insurance such as Medicaid or whose families are uninsured. Although we relied on a validated algorithm to determine enrollees’ T1DM–T2DM status, 21 some cases may have been misclassified. We found a greater female predominance among youth with T2DM than has been previously reported in the literature (typically 61% to 65% female), which may be due to differences in characteristics of the study samples.…”

Section: Discussionmentioning

confidence: 99%

“…21 Briefly, children younger than 10 years at their first DM diagnosis were considered to have T1DM. Among youth 10 years or older, those who were prescribed only insulin in the 730 days after initial diagnosis were also considered to have T1DM.…”

Section: Methodsmentioning

confidence: 99%

“…This algorithm had a sensitivity and specificity of 98.6% and 78.2% for detecting T1DM, and 83.2% and 97.5% for T2DM, among youth in a Canadian study. 21 …”

Section: Methodsmentioning

confidence: 99%

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Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

et al. 2017

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Objectives Despite the increasing prevalence of Type 2 diabetes mellitus (T2DM) among children and adolescents, little is known about their risk of developing diabetic retinopathy (DR). We sought to identify risk factors for DR in youth with DM, to compare DR rates for youth with Type 1 diabetes mellitus (T1DM) and T2DM, and to assess whether adherence to DR screening guidelines promoted by the American Academy of Ophthalmology, American Academy of Pediatrics, and American Diabetes Association adequately capture youth with DR. Design Retrospective observational longitudinal cohort study. Participants Youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network. Main Outcome Measure Hazard ratios (HR) with 95% confidence intervals (CIs) for developing DR. Methods In this study of youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network who were under ophthalmic surveillance, we identified the incidence and timing of DR onset for youth with T1DM and T2DM. Kaplan-Meier survival curves assessed the timing of initial diagnosis of DR for youth with each type of diabetes. Multivariable Cox proportional hazard regression modeling identified factors associated with the hazard of developing DR. Model predictors were age and calendar year at initial diabetes mellitus diagnosis, sex, race/ethnicity, net worth, and glycosylated hemoglobin (HbA1c). Results Among the 2240 youth with T1DM and 1768 youth with T2DM, 20.1% and 7.2% developed DR, over a median follow-up of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youth with T1DM developed DR faster than youth with T2DM (P<0.0001). For every one-point increase in HbA1c, the hazard for DR increased by 20% (HR=1.20, CI 1.06–1.35) and 30% (HR=1.30, CI 1.08–1.56) among youth with T1DM and T2DM, respectively. Current guidelines suggest ophthalmic screening begin 3–5 years after initial DM diagnosis, at which point in our study, over 18% of youth with T1DM had already had received ≥1 DR diagnosis. Conclusions Youth with T1DM or T2DM exhibit a considerable risk for DR and should undergo regular screenings by eye-care professionals to ensure timely DR diagnosis and limit progression to vision-threatening disease.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

et al. 2017

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“…27 In brief, children younger than 10 years at their first diabetes diagnosis were considered to have type 1 diabetes. Among children 10 years or older, those who were prescribed only insulin in the 730 days after initial diagnosis were also considered to have type 1 diabetes.…”

Section: Methodsmentioning

confidence: 99%

“…This algorithm had a sensitivity of 98.6% and a specificity of 78.2% for detecting type 1 diabetes and 83.2% sensitivity and 97.5% specificity for detecting type 2 diabetes in a Canadian study of youths with diabetes. 27 …”

Section: Methodsmentioning

confidence: 99%

Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network

et al. 2017

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IMPORTANCE Ophthalmic screening to check for diabetic retinopathy (DR) is important to prevent vision loss in persons with diabetes. The American Academy of Ophthalmology recommends that ophthalmic screening for DR occur beginning at 5 years after initial diabetes diagnosis for youths with type 1 diabetes; the American Diabetes Association recommends screening of youths with type 2 diabetes at the time of initial diagnosis. To our knowledge, it is unknown to what extent youths with diabetes obtain eye examinations in accordance with these guidelines.OBJECTIVE To assess the rate of obtaining ophthalmic examinations and factors associated with receipt of eye examinations for youths with diabetes. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, longitudinal cohort study examined youths 21 years or younger with newly diagnosed diabetes enrolled in a US managed care network from January 1, 2001, through December 31, 2014. MAIN OUTCOMES AND MEASURES Kaplan-Meier survival curves estimated the time from initial diabetes diagnosis to first eye examination by an ophthalmologist or optometrist. Multivariable Cox proportional hazards regression models identified factors associated with receiving an ophthalmic examination after initial diabetes diagnosis. RESULTS Among 5453 youths with type 1 diabetes (median age at initial diagnosis, 11 years; interquartile range, 8-15 years; 2972 male [54.5%]; 4505 white [82.6%]) and 7233 youths with type 2 diabetes (median age at initial diagnosis, 19 years; interquartile range, 16-22 years; 1196 male [16.5%]; 5052 white [69.9%]), 64.9% of patients with type 1 diabetes and 42.2% of patients with type 2 diabetes had undergone an eye examination by 6 years after initial diabetes diagnosis. Black youths (1367 [10.8%] of the sample) had an 11% and Latino youths (1450 [11.4%] of the sample) had an 18% decreased hazard of undergoing an eye examination by 6 years compared with white youths (black youths: adjusted hazard ratio [HR], 0.89; 95% CI, 0.79-0.99; Latino youths: HR, 0.82; 95% CI, 0.73-0.92). As household net worth increased, youths were increasingly more likely to undergo an eye examination by 6 years after initial diabetes diagnosis

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Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents

Sohn

Talbert

Blumenschein

et al. 2015

Pharmacoepidemiol Drug Saf

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Purpose To estimate the risk of type II diabetes (T2DM) in children and adolescents initiating atypical antipsychotic (AAP) therapy. Methods We conducted a retrospective cohort study using a new user design approach. Medical and pharmacy claims data between 1 January 2007 and 31 December 2009 for dependents ages 4 to 18 from an employed, commercially insured population from across the USA were included. AAP exposure was defined in the presence of a pharmacy claim preceded by at least six months of AAP-free history. We used propensity score (PS) methodology to identify and match incident AAP users and non-users. New-onset T2DM, was defined based on medical and pharmacy claims. Follow-up was extended until the date of new-onset T2DM or the end of the study period. The risk of T2DM was evaluated in an intent to treat fashion using the Kaplan–Meier estimator and Cox proportional hazard regression that provided hazard ratio (HR) and associated 95% confidence interval (CI). Results Our study population included 6236 new AAP users and 22 080 non-users. In this PS-matched sample, the estimated risk of T2DM was twice as high in AAP users as non-users (HR 2.18, 95% CI 1.45–3.29). Noticeable risk differences between AAP-treated and control groups materialized within four months of AAP initiation and became constant after six months until the end of the follow-up. Conclusions Children and adolescents who were prescribed an AAP medication had a two times higher risk of developing T2DM; our study raises questions about continued AAP use in children and adolescents.

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Validation of classification algorithms for childhood diabetes identified from administrative data

Abstract: Demographic characteristics in combination with drug-utilization patterns can be used to differentiate diabetes type among cases of pediatric diabetes identified within administrative health databases. Validation of similar algorithms in other regions is warranted.

Cited by 35 publications

References 20 publications

Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network

Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents

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