BMJ Open Diabetes Research & Care (Nov 2024)

Identification of atypical pediatric diabetes mellitus cases using electronic medical records

  • ,
  • Christine Lee,
  • Mohsen Bahmani Kashkouli,
  • Irl B Hirsch,
  • Jordan Smith,
  • Rebecca Lorch,
  • Jose C Florez,
  • Pengfei Liu,
  • Jeffrey P Krischer,
  • Beena Akolkar,
  • Ashok Balasubramanyam,
  • Christopher Eberhard,
  • Steven Fiske,
  • Jennifer Garmeson,
  • Christina Karges,
  • Noah Sulman,
  • Michael Toth,
  • Mustafa Tosur,
  • Marcela Astudillo,
  • Catherine Pihoker,
  • Sara Cromer,
  • Jennifer Scott,
  • Toni I Pollin,
  • Maria J Redondo,
  • Stephanie Sisley,
  • Pablo Ruiz,
  • Mary Larkin,
  • Wendy K Chung,
  • Lee-Jun Wong,
  • Aniko Sabo,
  • William Marshall,
  • Louis H Philipson,
  • Rita Hench,
  • Elif A Oral,
  • Kieren Mather,
  • Neda Rasouli,
  • Lainie Friedman Ross,
  • Janet McGill,
  • Paula Newton,
  • Baris Akinci,
  • Mary Ann Banerji,
  • Steven E Kahn,
  • Sarah Adams,
  • Hongzheng Dai,
  • Victoria Chen,
  • Maaz Ahmed,
  • Stephen Stone,
  • Rebecca Wood,
  • Emily Sims,
  • Aaron Deutsch,
  • Sarah Müller,
  • John Buse,
  • Jacqueline Lonier,
  • Nopporn Thangthaeng,
  • Marcela F Astudillo,
  • William E Winter,
  • Liana K Billings,
  • Raymond Kreienkamp,
  • William Craigen,
  • Ansley Davis,
  • Monica Dussan,
  • Jordana Faruqi,
  • Ruchi Gaba,
  • Mark Herman,
  • Shalini Jhangiani,
  • Elizabeth Kubota-Mishra,
  • Iliana Migacz,
  • Nkechinyere Osuji,
  • Jennifer Posey,
  • Nalini Ram,
  • Alejandro Siller,
  • Eric Venner,
  • Adriana Cardenas,
  • Dimpi Desai,
  • Mary Fang,
  • Erica Hattery,
  • Adrienne Ideouzu,
  • Julizza Jimenez,
  • Nupur Kikani,
  • Graciela Montes,
  • David Murdock,
  • Nikalina G O’Brien,
  • Robin Goland,
  • Anabel Evans,
  • Rachelle Gandica,
  • Rudolph Leibel,
  • Kaisha Mofford,
  • James Pring,
  • Carmella Evans-Molina,
  • Farrah Anwar,
  • Hannah Lease,
  • Angelica Mckibben,
  • Gabriela Monaco,
  • Zeb Saeed,
  • Maria Spall,
  • Marimar Hernandez-Perez,
  • Kelly Moors,
  • Anna Neyman,
  • Miriam S Udler,
  • Julia Douvas,
  • Melton Fan,
  • Cristinia Fernandez Hernandez,
  • Evelyn Greaux,
  • Saadhvi Kartik,
  • Pam Ricevuto,
  • Armen I Yerevanian,
  • Melissa Calverley,
  • Kathy Chu,
  • Mariella Facibene,
  • Christopher Han,
  • Dorit Koren,
  • Micah Koss,
  • Amy Sabean,
  • Jordan Sherwood,
  • Necole Brown,
  • Lina Soni,
  • Lorraine Thomas,
  • Jennifer Abrams,
  • Kylnt Bally,
  • Beisi Ji,
  • Samara Skiwiersky,
  • SiriAtma W Greeley,
  • Graeme Bell,
  • Shanna Banogon,
  • Jui Desai,
  • Anisa Dye,
  • David Ehrmann,
  • Lisa R Letourneau-Freiberg,
  • Carlin Lockwood,
  • Kynnedie Maloz,
  • Rochelle N Naylor,
  • Kaylee Oppenheimer,
  • Erin Papciak,
  • Karen Rodriguez,
  • Rachel Son,
  • Manu Sundaresan,
  • Chelsea Wu,
  • Colleen Bender,
  • Persephone Tian,
  • PA-C Chelsea Baker,
  • Megan Riff,
  • Courtney King,
  • Wyatt Pfau,
  • Avinash Pyreddy,
  • Marjan Rezaei,
  • Katlyn Sawyer,
  • Vatsala Singh,
  • Jules Barklow,
  • Noosha Farhat,
  • Andrew Her,
  • Carter Odean,
  • Gregory Schleis,
  • Chantal Underkofler,
  • Hadley Bryan,
  • Ryan Jollie,
  • Kristin Maloney,
  • Jennifer Marron,
  • Ryan Miller,
  • Maria Eleni Nikita,
  • Knightess Oyibo,
  • Kristi Silver,
  • Hilary Whitlatch,
  • Cindi Young,
  • Kathleen Palmer,
  • Stephanie Riley,
  • Devon Nwaba,
  • Elizabeth Streeten,
  • Jessica Tiner,
  • David Broome,
  • Merve Celik-Gular,
  • Tae-Hwa Chun,
  • Anabela Dill Gomes,
  • Maria Foss de Freitas,
  • Brigid Gregg,
  • Donatella Gilio,
  • Seda Grigoryan,
  • Diarratou Kaba,
  • Melda Sonmez Ince,
  • Adam Neidert,
  • Carman Richison,
  • Salman Imam,
  • Jamie Diner,
  • Cassandra Donahue,
  • Rachael Fraser,
  • Karla Fulghum,
  • Faryal Gilani,
  • Tahereh Ghorbani,
  • Alex Kass,
  • Nina Jain,
  • Klara Klein,
  • Lauren Larison,
  • Brooke Matson,
  • Catherine Morba,
  • Chase Armstrong,
  • Sue Kirkman,
  • Jesica Baran,
  • Rosanna Holod,
  • Dori Khakpour,
  • Patali Mandava,
  • Lori Sameshima,
  • Xiaofu Dong,
  • Thanmai Kalerus,
  • Beth Loots,
  • Kathleen Santarelli,
  • Cisco Pascual,
  • Kevin Niswender,
  • Norma Edwards,
  • Justin Gregory,
  • Alvin Powers,
  • Andrea Ramirez,
  • Fumihiko Urano,
  • Samantha Adamson,
  • Cris Brown,
  • Joel Brune,
  • Mary Jane Clifton,
  • Jing Hughes,
  • Stacy Hurst,
  • Isabella Paolicelli,
  • Brittany Zwijack,
  • Toko Campbell,
  • Jennifer May,
  • Rajesh Adusumalli,
  • Bruce Albritton,
  • Analia Aquino,
  • Paul Bransford,
  • Nicholas Cadigan,
  • Laura Gandolfo,
  • Joseph Gomes,
  • Robert Gowing,
  • Juan Herrera,
  • Callyn Kirk,
  • Jean Morissette,
  • Hemang M Parikh,
  • Francisco Perez-Laras,
  • Cassandra L Remedios,
  • Lili Wurmser,
  • Brandy Hutchinson,
  • Sidhvi Nekkanti,
  • MacKenzie Brandes,
  • Noël Burtt,
  • Jason Flannick,
  • Ryan Koesterer,
  • Phebe Olorunfemi,
  • Ahmed Alkanaq,
  • Lizz Caulkins,
  • Clive Wasserfall,
  • David Pittman,
  • William Winter,
  • David J Carey,
  • Daniel Hood,
  • Santica M Marcovina,
  • Christopher B Newgard

DOI
https://doi.org/10.1136/bmjdrc-2024-004471
Journal volume & issue
Vol. 12, no. 6

Abstract

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Introduction There are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical records (EMR).Research design and methods We tested two strategies in a large pediatric hospital in the USA. Strategy 1: we designed a questionnaire to rule out typical diabetes and applied it to the EMR of 100 youth with diabetes. Strategy 2: we built three electronic queries to generate reports of three atypical pediatric diabetes phenotypes: unknown type, type 2 diabetes (T2D) diagnosed <10 years old and autoantibody-negative type 1 diabetes (AbNegT1D).Results Strategy 1 identified six cases (6%) of atypical diabetes (mean diagnosis age=11±2.6 years, 16.6% men, 33% non-Hispanic white (NHW) and 66.6% Hispanic). Strategy 2: unknown diabetes type: n=68 (1%) out of 6676 patients with diabetes; mean diagnosis age=12.6±3.3 years, 32.8% men, 23.8% NHW, 47.6% Hispanic, 25.4% African American (AA), 3.2% other. T2D <10 years old: n=64 (6.6%) out of 1142 patients with T2D; mean diagnosis age=8.6±1.6 years, 20.3% men, 4.7% NHW, 65.6% Hispanic, 28.1% AA, 1.6% other. AbNegT1D: n=38 (5.6%) out of 680 patients with new onset T1D; mean diagnosis age=11.3±3.8 years; 57.9% men, 50% NHW, 19.4% Hispanic, 22.3% AA, 8.3% other.Conclusions In sum, we identified 1%–6.6% of atypical diabetes cases in a pediatric diabetes population with high racial and ethnic diversity using systematic review of the EMR. Better identification of these cases using unbiased approaches may advance precision diabetes.