Detection of Diabetes Status and Type in Youth using Electronic Health Records: The SEARCH for Diabetes in Youth Study

<u>Objective:</u> Diabetes surveillance often requires manual medical chart reviews to confirm status and type. This project aimed to create an electronic health record (EHR)-based procedure for improving surveillance efficiency through automation of case identification. <p><u> </u></p> <p><u>Research Design and Methods:</u> Youth (< 20 years) with potential evidence of diabetes (N=8,682) were identified from EHRs at three children’s hospitals participating in the SEARCH for Diabetes in Youth Study. True diabetes status/type was determined by manual chart reviews. Multinomial regression was compared with an ICD-10 rule-based algorithm in the ability to correctly identify diabetes status and type. Subsequently, the investigators evaluated a scenario of combining the rule based algorithm with targeted chart reviews where the algorithm performed poorly.</p> <p> </p> <p><u>Results:</u> The sample included 5308 true cases (89.2% type 1 diabetes). The rule-based algorithm outperformed regression for overall accuracy (0.955 vs 0.936). Type 1 diabetes was classified well by both methods: sensitivity (<i>Se</i>) (>0.95), specificity (<i>Sp</i>) (>0.96), and positive predictive value (PPV) (>0.97). In contrast, the PPVs for type 2 diabetes were 0.642 and 0.778 for the rule-based algorithm and the multinomial regression, respectively. Combining the rule-based method with chart reviews (n=695, 7.9%) of persons predicted to have non type 1 diabetes resulted in perfect PPV for the cases reviewed, while increasing overall accuracy (0.983). The sensitivity, specificity, and PPV for type 2 diabetes using the combined method were >=0.91. </p> <p> </p> <p><u>Conclusions</u>: An ICD-10 algorithm combined with targeted chart reviews accurately identified diabetes status/type and could be an attractive option for diabetes surveillance in youth. </p> <br>