Who Has Diabetes? Best Estimates of Diabetes Prevalence in the Department of Veterans Affairs Based on Computerized Patient Data

Abstract

OBJECTIVE -To optimize methods for identifying patients with diabetes based on computerized records and to obtain best estimates of diabetes prevalence in Department of Veterans Affairs (VA) patients.RESEARCH DESIGN AND METHODS -The VA Diabetes Epidemiology Cohort (DEpiC) is a linked national database of all VA patients since 1998 with data from VA medical visits, Medicare claims, pharmacy and laboratory records, and patient surveys. Using DEpiC, we examined concordance of diabetes indicators, including ICD-9-CM codes (250.xx), prescription drug treatment, HbA 1c tests, and patient self-report. We determined the optimal criterion for identifying diabetes and used it in estimating diabetes prevalence in the VA.RESULTS -The best criterion was a prescription for a diabetes medication in the current year and/or 2ϩ diabetes codes from inpatient and/or outpatient visits (VA and Medicare) over a 24-month period. This definition had high sensitivity (93%) and specificity (98%) against patient self-report, and reasonable rates of HbA 1c testing (75%). HbA 1c testing alone added few additional cases, and a single diagnostic code added many patients, but without confirmation (reduced specificity). However, including codes from Medicare was critical. Applying this definition for 1998 -2000, we identified an average of 500,000 VA patients with diabetes per year. We also estimated high and increasing diabetes prevalence rates of 16.7% in FY1998, 18.6% in FY1999, and 19.6% in FY2000 and an incidence estimated to be ϳ2% per year.CONCLUSIONS -Development and evaluation of methodology for analyzing computerized patient data can improve the identification of patients with diabetes. The increasing high prevalence of diabetes in VA patients will present challenges for clinicians and health system management.

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

“…45 In a study using the VA database, the sensitivity and specificity of ICD-9 codes in comparison to chart review to identify diabetes were 78.3 and 95.7 %, respectively. 46 The use of ICD-9 codes in general and AHRQ-CCS codes in particular in order to extract obesity diagnoses has been described in the literature [47][48][49][50] ; AHRQ-CCS codes for obesity have also been used to generate reports on utilization and cost statistics in relation to obesity. [51][52][53] In general, the use of ICD-9 codes to identify obesity has been noted as having low sensitivity but high specificity 45,54 ; using chart review as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value were 24.6 %, 99.3 %, 75.9 %, and 93.6 %.…”

Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes

“…The final study cohort included individuals with concurrent diagnoses of Type 2 diabetes, identified as those who had at least 2 inpatient or outpatient records with diagnostic codes of 250.x0 or 295.x2, 357.2, 362.0, or 366.41 (Miller et al, 2004) during the study period. In order to increase the precision of case identification for Type 2 diabetes, we excluded 1129 persons who either only had records with diagnostic codes of 250.x1 or 250.x3 (who may have had Type 1 diabetes) or who only had one or more prescriptions for hypoglycemic medications.…”

Geographic and Racial/Ethnic Variations in Patterns of Multimorbidity Burden in Patients with Type 2 Diabetes

“…We also present information on multimorbidity grouped by mental versus physical disorders. 20 The NPCD is the source for the VHA Medical SAS data sets used to analyze veteran clinical data such as diagnosis and procedure codes for outpatient visits and inpatient admissions. The PBM database includes utilization information for every prescription filled in the VA, with the Outpatient Pharmacy Package for individual prescriptions dispensed at the site's pharmacy, either as a new fill or a refill.…”