American Diabetes Association
Browse

Derivation and Validation of D-RISK: An Electronic Health Record-Driven Risk Score to Detect Undiagnosed Dysglycemia in Clinical Practice

figure
posted on 2025-01-17, 18:31 authored by Michael E. Bowen, Ildiko Lingvay, Luigi Meneghini, Brett Moran, Noel O. Santini, Song Zhang, Ethan A. Halm

Objective: We derive and validate D-RISK, an EHR-driven risk score to optimize and facilitate screening for undiagnosed dysglycemia (prediabetes + diabetes) in clinical practice. Research Design and Methods: We utilized retrospective EHR data (derivation sample) and a prospective diabetes screening study (validation sample) to develop D-RISK. Logistic regression with backwards selection was used to predict dysglycemia (HbA1c ≥5.7%) using diabetes risk factors consistently captured in structured EHR data. Model coefficients were converted to a points-based risk score. We report discrimination, sensitivity, and specificity and compare D-RISK to the American Diabetes Association (ADA) Risk Test and the ADA and US Preventive Services Task Force (USPSTF) screening guidelines. Results: The derivation cohort included 11,387 patients (mean age 48; 65% female; 42% Hispanic; 32% NH-black; mean BMI 32; 29% with hypertension). D-RISK included age, race, BMI, hypertension, and random glucose. The area under curve (AUC) for the risk score was 0.75 (95% CI 0.74-0.76). In the validation screening study (N=519), the AUC was 0.71 (95% CI 0.66-0.75) which was better than the ADA and USPSTF diabetes screening guidelines (AUC = 0.52 and AUC = 0.58 respectively; p<0.001 for both). Discrimination was similar to the ADA Risk Test (AUC = 0.67) using patient-reported data to supplement EHR data, although D-RISK was more sensitive (75% vs. 61%) at the recommended screening thresholds. Conclusions: Designed for use in the EHR, D-RISK performs better than commonly used screening guidelines and risk scores and may help detect undiagnosed cases of dysglycemia in clinical practice.

Funding

Research reported in this publication was supported by the National Institute of Diabetes Digestive and Kidney Diseases at the National Institutes of Health under Award Number K23DK104065. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

History

Usage metrics

    Diabetes Care

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC