An analysis of 11.5 million electronic patient records in the United States has identified a significant number of people with undiagnosed diabetes.

The study, by researchers in the United Kingdom and the U.S. and published in CMAJ Open, was led by Tim Holt at the University of Oxford. The study investigated electronic records for 11.5 million patients at more than 9,000 primary care clinics across the U.S. Researchers looked at diabetes coding in records, analyzed biochemical data using an algorithm and measured the quality of diabetes care.

Of the total 1,174,018 people with diabetes, 63,620 (5.4 percent) had undiagnosed diabetes, with a higher proportion in parts of Arizona, North Dakota, Minnesota, South Carolina, and Indiana.

“In some areas of the country, this amounted to 12 to 15.9 percent of the overall diabetes population. Although this is less than the 27.8 percent believed to have undiagnosed diabetes, these people were immediately identifiable through simple searches of electronic medical records from primary care practices,” the authors wrote.

Their findings also indicate that patients managed using electronic diabetes registers generally achieve better care quality, according to a wide range of measures. Use of electronic registers is a long established tradition in UK primary care but has taken longer to become part of U.S. practice.

“Wherever electronic diabetes registers are used to support the provision of care, and where blood glucose levels, HbA1c and quality-of-care data are recorded in the same system, it should be possible to identify readily (and at low cost) individuals at risk of their diabetes going undetected and those receiving suboptimal care," the authors concluded. "This applies across all nations using electronic medical records, including Canada.”

The study is available here.

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