Tessa L Crume1, Richard F Hamman1, Scott Isom2, Jasmin Divers2, Elizabeth J Mayer-Davis3, Angela D Liese4, Sharon Saydah5, Jean M Lawrence6, Catherine Pihoker7, Dana Dabelea1. 1. Department of Epidemiology, Colorado School of Public Health, University of Colorado, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center) Anschutz Medical Campus, Denver, Colorado, USA. 2. Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 3. School of Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA. 5. Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA. 6. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA. 7. Department of Pediatric Endocrinology, Children's Hospital & Regional Medical Center, Seattle, Washington, USA.
Abstract
BACKGROUND: Although surveillance for diabetes in youth relies on provider-assigned diabetes type from medical records, its accuracy compared to an etiologic definition is unknown. METHODS: Using the SEARCH for Diabetes in Youth Registry, we evaluated the validity and accuracy of provider-assigned diabetes type abstracted from medical records against etiologic criteria that included the presence of diabetes autoantibodies (DAA) and insulin sensitivity. Youth who were incident for diabetes in 2002-2006, 2008, or 2012 and had complete data on key analysis variables were included (n = 4001, 85% provider diagnosed type 1). The etiologic definition for type 1 diabetes was ≥1 positive DAA titer(s) or negative DAA titers in the presence of insulin sensitivity and for type 2 diabetes was negative DAA titers in the presence of insulin resistance. RESULTS: Provider diagnosed diabetes type correctly agreed with the etiologic definition of type for 89.9% of cases. Provider diagnosed type 1 diabetes was 96.9% sensitive, 82.8% specific, had a positive predictive value (PPV) of 97.0% and a negative predictive value (NPV) of 82.7%. Provider diagnosed type 2 diabetes was 82.8% sensitive, 96.9% specific, had a PPV and NPV of 82.7% and 97.0%, respectively. CONCLUSION: Provider diagnosis of diabetes type agreed with etiologic criteria for 90% of the cases. While the sensitivity and PPV were high for youth with type 1 diabetes, the lower sensitivity and PPV for type 2 diabetes highlights the value of DAA testing and assessment of insulin sensitivity status to ensure estimates are not biased by misclassification.
BACKGROUND: Although surveillance for diabetes in youth relies on provider-assigned diabetes type from medical records, its accuracy compared to an etiologic definition is unknown. METHODS: Using the SEARCH for Diabetes in Youth Registry, we evaluated the validity and accuracy of provider-assigned diabetes type abstracted from medical records against etiologic criteria that included the presence of diabetes autoantibodies (DAA) and insulin sensitivity. Youth who were incident for diabetes in 2002-2006, 2008, or 2012 and had complete data on key analysis variables were included (n = 4001, 85% provider diagnosed type 1). The etiologic definition for type 1 diabetes was ≥1 positive DAA titer(s) or negative DAA titers in the presence of insulin sensitivity and for type 2 diabetes was negative DAA titers in the presence of insulin resistance. RESULTS: Provider diagnosed diabetes type correctly agreed with the etiologic definition of type for 89.9% of cases. Provider diagnosed type 1 diabetes was 96.9% sensitive, 82.8% specific, had a positive predictive value (PPV) of 97.0% and a negative predictive value (NPV) of 82.7%. Provider diagnosed type 2 diabetes was 82.8% sensitive, 96.9% specific, had a PPV and NPV of 82.7% and 97.0%, respectively. CONCLUSION: Provider diagnosis of diabetes type agreed with etiologic criteria for 90% of the cases. While the sensitivity and PPV were high for youth with type 1 diabetes, the lower sensitivity and PPV for type 2 diabetes highlights the value of DAA testing and assessment of insulin sensitivity status to ensure estimates are not biased by misclassification.
Authors: Dana Dabelea; Arleta Rewers; Jeanette M Stafford; Debra A Standiford; Jean M Lawrence; Sharon Saydah; Giuseppina Imperatore; Ralph B D'Agostino; Elizabeth J Mayer-Davis; Catherine Pihoker Journal: Pediatrics Date: 2014-03-31 Impact factor: 7.124
Authors: Dana Dabelea; Jeanette M Stafford; Elizabeth J Mayer-Davis; Ralph D'Agostino; Lawrence Dolan; Giuseppina Imperatore; Barbara Linder; Jean M Lawrence; Santica M Marcovina; Amy K Mottl; Mary Helen Black; Rodica Pop-Busui; Sharon Saydah; Richard F Hamman; Catherine Pihoker Journal: JAMA Date: 2017-02-28 Impact factor: 56.272
Authors: Saskia E Vanderloo; Jeffrey A Johnson; Kim Reimer; Patrick McCrea; Kimberly Nuernberger; Hans Krueger; Sema K Aydede; Jean-Paul Collet; Shazhan Amed Journal: Pediatr Diabetes Date: 2011-07-19 Impact factor: 4.866
Authors: Jinan B Saaddine; Anne Fagot-Campagna; Deborah Rolka; K M Venkat Narayan; Linda Geiss; Mark Eberhardt; Katherine M Flegal Journal: Diabetes Care Date: 2002-08 Impact factor: 19.112
Authors: Dana Dabelea; Elizabeth J Mayer-Davis; Sharon Saydah; Giuseppina Imperatore; Barbara Linder; Jasmin Divers; Ronny Bell; Angela Badaru; Jennifer W Talton; Tessa Crume; Angela D Liese; Anwar T Merchant; Jean M Lawrence; Kristi Reynolds; Lawrence Dolan; Lenna L Liu; Richard F Hamman Journal: JAMA Date: 2014-05-07 Impact factor: 56.272
Authors: Michael Klompas; Emma Eggleston; Jason McVetta; Ross Lazarus; Lingling Li; Richard Platt Journal: Diabetes Care Date: 2012-11-27 Impact factor: 19.112
Authors: Jean M Lawrence; Mary Helen Black; Jian L Zhang; Jeff M Slezak; Harpreet S Takhar; Corinna Koebnick; Elizabeth J Mayer-Davis; Victor W Zhong; Dana Dabelea; Richard F Hamman; Kristi Reynolds Journal: Am J Epidemiol Date: 2013-10-07 Impact factor: 5.363
Authors: Amy S Shah; Scott Isom; Ralph D'Agostino; Lawrence M Dolan; Dana Dabelea; Giuseppina Imperatore; Amy Mottl; Eva Lustigova; Catherine Pihoker; Santica Marcovina; Elaine M Urbina Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152
Authors: Jean M Lawrence; Jasmin Divers; Scott Isom; Sharon Saydah; Giuseppina Imperatore; Catherine Pihoker; Santica M Marcovina; Elizabeth J Mayer-Davis; Richard F Hamman; Lawrence Dolan; Dana Dabelea; David J Pettitt; Angela D Liese Journal: JAMA Date: 2021-08-24 Impact factor: 157.335
Authors: Amy S Shah; Scott Isom; Dana Dabelea; Ralph D'Agostino; Lawrence M Dolan; Lynne Wagenknecht; Giuseppina Imperatore; Sharon Saydah; Angela D Liese; Jean M Lawrence; Cate Pihoker; Elaine M Urbina Journal: Cardiovasc Diabetol Date: 2021-07-07 Impact factor: 8.949