Missing risks in opportunistic screening for type 2 diabetes - CroDiabGP study

Abstract

<p><strong>Aim<br /></strong> To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record<br />(EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients’ data using Wonca International Classification Committee (WICC). Missing data were detected in each list.<br /><strong>Methods<br /></strong> A prospective study included a group of 1883 patients (aged 45-70) identified with risks. Risks were assessed based on<br />EMR for continuity variables and FM’s assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D.<br /><strong>Results<br /></strong> Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks<br />were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p<.001).<br /><strong>Conclusion<br /></strong> Two methods of extraction could not detect data for episodes of the disease. In the list of personal information, FMs<br />could not assess overweight for one in six patients and family history for every other patient. The study can stimulate improving coded and structured data in EMR.</p>