Validity of the primary care diagnosis of diabetes in veterans in the southeastern United States.
OBJECTIVE
To determine the validity of diagnosis of diabetes in primary care.


METHODS
Patients with initial primary care diagnosis (ICD-9 code 250.xx) were compared to matched controls (without code or diabetes drugs), and patients meeting VA Diabetes Epidemiology Cohort (DEpiC) criteria (any 250.xx twice, or diabetes drug) in "diagnostic accuracy" (whether hyperglycemia preceded diagnosis) and "predictive accuracy" (whether diabetes drug or A1c ≥ 6.5% followed diagnosis).


RESULTS
Only 1.8% of primary care diagnoses met ADA criteria, while nonstandard non-fasting morning glucose ≥ 126 mg/dl or A1c ≥ 6.5% were utilized in 51.5%; broad "diagnostic accuracy" criteria were met in 53% of 2980 primary care vs. 2% of 13,397 control (p<0.001), and 60% of 2456 DEpiC patients (p<0.001). "Predictive accuracy" was 88% in primary care diagnosis vs. 12% control (p<0.001) and 93% DEpiC patients (p=0.08), but was higher if ADA criteria were met. Delay from hyperglycemia to diagnosis averaged 12.5 months in primary care vs. 20.1 months in DEpiC patients (p<0.001).


CONCLUSIONS
While generally not based on ADA criteria, the primary care diagnosis of diabetes is valid, and identifies patients earlier than detection by DEpiC criteria. Either primary care diagnosis or DEpiC criteria could be used to trigger electronic reminders aimed to facilitate management.
Veterans' Affairs Medical Center, Decatur, GA, USA.
Jennifer G
JG
Twombly
Qi
Q
Long
Ming
M
Zhu
Lisa-Ann
LA
Fraser
Darin E
DE
Olson
Peter W F
PW
Wilson
K M Venkat
KM
Narayan
Lawrence S
LS
Phillips
D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000175:diagnosis*; D042241:Early Diagnosis; D006801:Humans; D006943:Hyperglycemia; D011320:Primary Health Care; D015206:Southwestern United States; D014728:Veterans