Undiagnosed Diabetes
QResearch-EMIS Search
Strategy
Julia Hippisley-Cox/Shaun O’Hanlon/David Stables
Version No 1.-0
Revision History
Revision date
Version
Summary of Changes
01 March 2008
V1.0
First issue
© Copyright QRESEARCH/EMIS
No part of this document may be sold, hired, reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording and information storage and retrieval systems for any other purpose
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that your EMIS/QResearch documentation is up to date, but our commitment to constantly improve our software
and systems means that there may have been changes since this document was produced.
Undiagnosed Diabetes QResearch-EMIS Search Strategy
Contents
1 Purpose of the document ........................................................................................................... 3
2 Research summary .................................................................................................................... 3
2.1.1 Research aim ................................................................................................................................................. 3
2.1.2 Method ........................................................................................................................................................... 3
2.1.3 Results ........................................................................................................................................................... 3
2.1.4 Conclusion ..................................................................................................................................................... 3
3 Missing Diabetics Search Definition ........................................................................................... 4
3.1 Read code Sets ................................................................................................................................ 4
3.2 Search A: Patients likely to be Diabetic Based on last Blood Sugar Level ........................................ 5
3.3 Search B: Patients who might be Diabetic Based on last Blood Sugar Level .................................... 6
4 Acnowledgements ...................................................................................................................... 7
5 References ................................................................................................................................. 7
6 Further details............................................................................................................................. 7
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© Copyright EMIS/QResearch2016
Undiagnosed Diabetes QResearch-EMIS Search Strategy
1 Purpose of the document
This document gives the technical specification of the Qresearch-EMIS search strategy to identify patients
with possible or probably undiagnosed diabetes as described in the recent research paper published in
the British Journal of General Practice1 and now implemented into EMIS Clinical Systems in November
2006.
The precise strategy was developed and refined using the QResearch database which is a very large
anonymised research database containing the records of more than 10 million patients from 550 practices
over the last 20 years.
2 Research summary
2.1.1 Research
aim
Around 1% of the UK population has diabetes that is either undiagnosed or unrecorded on practice
disease registers. The aim of the study was to estimate the number of people in UK primary care
databases with biochemical evidence of undiagnosed diabetes and to develop simple practice-based
search techniques to support early recognition of diabetes.
2.1.2 Method
We undertook a cross-sectional survey of 3 630 296 patient electronic records from 480 practices
contributing toe the Qresearch database. Electronic searches to identify people with no diabetes diagnosis
in one of two categories (A and B), using the most recently recorded blood glucose measurement: random
blood glucose level ≥11.1 mmol/l or fasting blood glucose level ≥7.0 mmol/l (A); either a random or a
fasting blood glucose level ≥7.0 mmol/l (B). An additional outcome measure was the proportion of the
population with at least one blood glucose
measurement in the record.
2.1.3 Results
The number (percentage) identified in category A was 3758 (0.10% of the total population); the number in
category B was 32 785 (0.90%). Projected to a practice of 7000 patients, around eight patients have
biochemical evidence of undiagnosed diabetes, and 68 have results suggesting the need for further
follow-up. One-third of people aged over 40 years without diabetes have a blood glucose measurement in
the past 2 years in their record.
2.1.4 Conclusion
People with possible undiagnosed diabetes are readily identifiable in UK primary care databases through
electronic searches using blood glucose data. People with borderline levels, who may benefit from
interventions to reduce their risk of progression to diabetes, can also be identified using practice-based
software.
© Copyright QRESEARCH/EMIS 2016
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Undiagnosed Diabetes QResearch-EMIS Search Strategy
3 Missing Diabetics Search Definition
3.1 Read
code Sets
Field Name
Description
Read code
DIAB_COD
Diabetes
C10%
DIABEXC_COD
Diabetes Excluded
1I0
DIABRES_COD
Diabetes Resolved
212H
DIABPREG_COD
Diabetes in Pregnancy
L180
IGT_COD
Impaired Glucose Tolerance /
Impaired Fasting Glycaemia
C11y2
C11y3
R10E
R10D0
FGLUC_COD
Fasting Glucose Level
44f1
44g1
44TK
44T2
RGLUC_COD
Random Glucose Level
44f
44f0
44g
44g0
44TJ
44U
44T1
4Q80
GTT_COD
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Normal Glucose Tolerance Test
44V1
© Copyright EMIS/QResearch2016
Undiagnosed Diabetes QResearch-EMIS Search Strategy
3.2 Search
A: Patients likely to be Diabetic Based on last Blood Sugar Level
This search will identify patients who don’t have a diagnosis of Diabetes (or impaired glucose
tolerance) or have not had a diagnosis of diabetes excluded (by a normal glucose tolerance test or an
appropriate Read Code). It will then query the last blood sugar level recorded in the patients
electronic health record; Patients are included in the results if a fasting test is above 7.0 or a nonfasting is above 11.0 mmol/l.
Denominator
All Registered Patients
Numerator
No
Operator
1
Rule
If True
If False
REJECT
NEXT
REJECT
NEXT
REJECT
NEXT
REJECT
NEXT
SELECT
REJECT
DIAB_COD or DIABRES_COD
AND
Get Latest
Test Code = DIAB_COD
2
3
4
AND
AND
AND
5
IGT_COD
DIABPREG_COD
Any in last 9 months
DIABEXC_COD
Find Records FGLUC_COD or RGLUC_COD
or GTT_COD
Get LASTEST
Test Code = FGLUC_COD
OR
Value >= 7.0
Find Records FGLUC_COD or RGLUC_COD
or GTT_COD
Get LASTEST
Test Code = RGLUC_COD
Value > 11.0
© Copyright QRESEARCH/EMIS 2016
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Undiagnosed Diabetes QResearch-EMIS Search Strategy
3.3 Search
B: Patients who might be Diabetic Based on last Blood Sugar Level
This search will identify patients who don’t have a diagnosis of Diabetes (or impaired glucose
tolerance) or have not had a diagnosis of diabetes excluded (by a normal glucose tolerance or an
appropriate Read Code). It will then query the last blood sugar level; Patients are included in the
results if the level (fasting or non-fasting) test is above 7.0 mmol/l.
Denominator
All currently registered patients
Numerator
No
Operator
1
Rule
If True
If False
REJECT
NEXT
REJECT
NEXT
REJECT
NEXT
DIAB_COD or DIABRES_COD
OR
Get Latest
Test Code = DIAB_COD
2
3
AND
AND
IGT_COD
DIABPREG_COD
Any in last 9 months
3
AND
DIABEXC_COD
REJECT
NEXT
4
AND
Find Records FGLUC_COD or RGLUC_COD
or GTT_COD
SELECT
REJECT
Get LASTEST
Test Code = FGLUC_COD or RGLUC_COD
Value >= 7.0
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© Copyright EMIS/QResearch2016
Undiagnosed Diabetes QResearch-EMIS Search Strategy
4 Acnowledgements
We acknowledge the contribution of EMIS practices who freely contribute to the QResearch database and
to EMIS and the University of Nottingham for developing and supporting the database as a biomedical
resource. We acknoelwge the academic contribution of Tim Holt, David Stables, Julia Hippisley-Cox,
Shaun O’Hanlon and Azeem Majeed who undertook the original research published in the British Journal
of General Practice.
5 References
1. Holt T, Stables D, Hippisley-Cox J, O'Hanlon S, Majeed A. Identifying undiagnosed diabetes: crosssectional survey of 3.6 million patients' electronic records. British Journal of General Practice
2008;58:192-196.
6 Further details
Further details about the research itself can be found online at
http://www.qresearch.org/Public_Documents/Holt%20BJGP%202008.pdf.
Further details about QResearch database used for this research and related research projects can be
found on http://www.qresearch.org.
EMIS is the largest supplier of primary care IT systems in the UK providing clinical computer systems to
two thirds of general practices. Further details about the EMIS clinical system can be found at
http://www.emis-online.com/
© Copyright QRESEARCH/EMIS 2016
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