title: Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners' electronic medical records: a validation study Diabetes control and complications in private primary healthcare in Malaysia. Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey. Treatment of type 2 diabetes mellitus in a primary care setting in Taiwan: comparison with secondary/tertiary care. The Impact of Patient-Centered versus Didactic Education Programs in Chronic Patients by Severity: The Case of Type 2 Diabetes Mellitus.
abstract: Objectives The Italian project MATRICE aim ed to assess how well cases of type 2 diabetes ( T2DM ) , hypertension , ischaemic heart disease ( IHD ) and heart failure ( HF ) and their levels of severity can be automatically extracted from the Health Search /CSD Longitudinal Patient Data base ( HSD ) . From the medical records of the general practitioners ( GP ) who volunteered to participate , cases were extracted by algorithms based on diagnosis codes , keywords , drug prescriptions and results of diagnostic tests . A r and om sample of identified cases was vali date d by interviewing their GPs . Setting HSD is a data base of primary care medical records . A panel of 12 GPs participated in this validation study . Participants 300 patients were sample d for each disease , except for HF , where 243 patients were assessed . Outcome measures The positive predictive value ( PPV ) was assessed for the presence/absence of each condition against the GP 's response to the question naire , and Cohen 's κ was calculated for agreement on the severity level . Results The PPV was 100 % ( 99 % to 100 % ) for T2DM and hypertension , 98 % ( 96 % to 100 % ) for IHD and 55 % ( 49 % to 61 % ) for HF . Cohen 's kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD . Conclusions This study shows that individuals with T2DM , hypertension or IHD can be validly identified in HSD by automated identification algorithms . Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions , but some misclassification occurs . For HF , further research is needed to refine the current algorithm This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia . A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed . The majority of patients ( 96.5 % ) had type 2 diabetes mellitus and 81.4 % had BMI > or = 23 kg/m2 . Only 12.0 % of the patients had their HbA1c measured in the preceding 12 months . As for glycaemic control only 20 % of the patients had HbA1c < 7 % and 11 % had FPG < 6.7 mmol/L. As for lipid levels , only 12.3 % of the patients had total cholesterol < 4.8 mmol/L ; 30.9 % had HDL-cholesterol > 1.2 mmol/L and 49.8 % had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia . only 12.4 % of the patients were on lipid lowering therapy . As for blood pressure , 55.9 % of the patients had systolic pressure > or = 140 mmHg and 40.9 % had diastolic pressure > or = 90 mmHg . However , only 32.4 % of the patients were on  antihypertensive medication .  Only 37.4 % of the patients admitted to adhering to diabetic diet regularly  and 32.0 %  exercised regularly . As for glucose monitoring only 6.9 % of the patients did  home blood glucose monitoring  and 6.2 % did  home urine glucose .  There was also a high complication rate with the commonest being neuropathy ( 30.1 % ) followed by background retinopthy ( 23.5 % ) , albuminuria ( 22.9 % ) and microalbuminuria ( 20.4 % ) . In conclusion , the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications . There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets OBJECTIVES To investigate prospect ively the incidence , certain predictors and outcomes of type 2 diabetes ( DM ) , as well as to determine its prevalence cross-sectionally , in a representative sample of Turkish men and women . METHODS Prospect i ve evaluation of 3401 male and female participants ( aged 48.2 + /-12 years ) . Follow-up constituted 19,050 person-years . Individuals with DM were diagnosed with criteria of the American Diabetes Association .  Fatal and nonfatal coronary heart disease ( CHD ) was identified by clinical findings and Minnesota coding of resting electrocardiograms . Cut-points of > or = 95 cm in males and > or = 91 cm in females were selected for abdominal obesity . For prospect i ve evaluations , cases with DM or CHD were excluded . RESULTS Prevalence of  DM in Turkish adults was estimated as 2.89 million ( 11.0 % of the population aged > or = 35 years ) . Over a mean follow-up of 5.9 years , incident DM developed in 223 subjects , yielding an incidence per 1000 person-years of 11.0 in women and 12.4 in men . This corresponded to a 300,000 annual incidence . Following risk parameter levels but not HDL-cholesterol were significantly elevated at baseline in subjects developing DM compared to those without : age ( 5 years ) , waist girth ( 7 cm ) , blood pressure ( 12/6 mmHg ) , apolipoprotein B ( 7 mg/dl ) , total cholesterol ( 14 mg/dl ) , and fasting triglycerides ( only in women , 52 mg/dl ) . Abdominal obesity ( RR 2.61 [ 95%CI 1.87 ; 3.63 ] ) and age in both genders , hypertension ( RR 1.81 [ 95%CI 1.10 ; 2.98 ] ) and low HDL-cholesterol in men alone were significant independent predictors of DM . Diabetes mellitus was a significant and independent predictor of fatal and nonfatal CHD , with a RR of 1.81 ( 95%CI 1.19 ; 2.75 ) , after adjustment for sex , age , hypertension , waist circumference , serum total cholesterol and smoking status . CONCLUSIONS The annual incidence of DM in Turkey rises very rapidly , currently st and s at 300,000 , and , hence , its prevalence also rises correspondingly . Insulin resistance appears to be a weak determinant of DM in Turkish women while abdominal obesity is the main determinant . Multivariately adjusted DM is a significant independent predictor of fatal and nonfatal CHD . These observations emphasize that measures to reverse or stop the " epidemic " of abdominal obesity are severely required BACKGROUND This study investigated the status of diabetes control and management in patients treated in a primary healthcare setting and compared the results with data previously obtained for secondary /tertiary care patients in Taiwan . METHODS This study was conducted at 51 primary healthcare stations r and omly selected isl and -wide in Taiwan in 2001 . A total of 1302 type 2 diabetes patients who had been followed-up for more than 1 year were included .  Blood was collected for central ized HbA1c assay . The remaining data and information were collected by review of medical records and patient interview . RESULTS Compared with the results of a previous study on patients treated in a secondary /tertiary care setting , a significantly smaller percentage of primary care patients were receiving insulin therapy . Primary care patients also had a shorter duration of diabetes , a higher HbA1c level , better blood pressure control and a lower prevalence of complications . The proportion of patients achieving optimal control of glycemia and blood pressure was low . Patients aged < 65 years had a significantly shorter duration of diabetes , poorer diabetes control and better blood pressure control than elderly patients aged > or = 65 years . Primary care patients aged > or = 65 years had a significantly higher frequency of stroke than those aged < 65 years . The elderly group of secondary /tertiary care patients had a significantly higher frequency of coronary heart disease and stroke . Duration of diabetes and hypertension were the leading risk factors for complications in diabetes patients treated in both primary and secondary /tertiary care setting s. CONCLUSION Diabetes control was poorer in primary care than in secondary /tertiary care patients , but control of blood pressure was better in primary care patients . The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged < 65 years compared with their elderly counterparts might be related to a lower prevalence of complications BACKGROUND Education leads to better health-related decisions and protective behaviors , being especially important for patients with chronic conditions .  Self-management education programs have been shown to be beneficial for patients with different chronic conditions and to have a higher impact on health outcomes than does didactic education . OBJECTIVE To investigate improvements in glycemic control ( measured by glycated hemoglobin A1c ) in patients with type 2 diabetes mellitus . METHODS Our comparative trial involved one group of patients receiving patient-centered education and another receiving didactic education .  We dealt with selection bias issues , estimated the different impact of both programs , and vali date d our analysis using quantile regression techniques . RESULTS We found evidence of better mean glycemic control in patients receiving the patient-centered program , which engaged better patients . Nevertheless , that differential impact is nonmonotonic . Patients initially at the healthy range at the patient-centered program maintained their condition better . Patients close to , but not within , the healthy range benefited equally from attending either program . Patients with very high  glycemic level benefited significantly more from attending the patient-centered program . Finally , patients with the worst initial glycemic control ( far from the healthy range ) improved equally their diabetic condition , regardless of which program they attended . CONCLUSIONS Different patients are sensitive to different categories of education programs . The optimal , cost-effective design of preventative programs for patients with chronic conditions needs to account for the different impact in different " patient categories . " This implies stratifying patients and providing the appropriate preventative education program , or looking for alternative policy implementations for unresponsive patients who have the most severe condition and are the most costly
target: The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions .
background: INTRODUCTION The increasing prevalence of type 2 diabetes mellitus ( T2DM ) presents a significant burden on affected individuals and healthcare systems internationally .
  There is , however , no agreed vali date d measure to infer diabetes severity from electronic health records ( EHRs ) .
  We aim to quantify T2DM severity and vali date it using clinical adverse outcomes .