Sinai Health System, Division of General Internal Medicine, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2024 Aug 29;19(8):e0307581. doi: 10.1371/journal.pone.0307581. eCollection 2024.
In Canada, one in seven adults has diabetes (i.e., 2.3 million) and the lifetime risk of developing diabetes is approximately 30% by age 65. Although 30% of patients admitted to the hospital have diabetes, data from inpatient hospitalizations for patients with diabetes are lacking, both in Canada and globally.
To validate International Classification of Diseases 10th edition Canadian version (ICD-10-CA) codes for the identification of patients with diabetes, to create a multicenter database of patients with diabetes hospitalized under internal medicine in Ontario, and to determine their baseline characteristics, medication use, and admission characteristics.
We created a database of people who had diabetes and were hospitalized between 2010 and 2020 at 8 hospitals in Ontario that were part of the General Medicine Inpatient Initiative (GEMINI) hospital data-sharing network. Patients who had diabetes were identified using chart review, based upon either (i) a previous physician diagnosis of diabetes, (ii) a recorded hemoglobin A1c ≥ 6.5% or (iii) outpatient prescription of a diabetes medication preceding the hospitalization. The test characteristics of ICD-10-CA codes for diabetes were evaluated. We compared baseline demographics, medication use and hospitalization details among patients with and without diabetes. For hospitalization details, we collected information on the admission diagnosis, comorbidity index, length of stay, receipt of ICU-level care, and inpatient mortality.
There were 384,588 admissions within the total study cohort, of which 118,987 (30.9%) had an ICD-10-CA diagnosis code of diabetes (E10.x, E11.x, E13.x, E14.x). The sensitivity and specificity of ICD-10-CA diagnostic codes was 95.9% and 98.8%, respectively. Most patients with an ICD-10-CA code for diabetes had a code for type 2 diabetes (93.9%) and a code for type 1 diabetes was rare (6.1%). The mean age was 66.4 years for patients without diabetes and 71.3 years for those with an ICD-10-CA diagnosis code for diabetes. Patients with diabetes had a higher prevalence of hypertension (64% vs. 37.9%), coronary artery disease (28.7% vs. 15.3%), heart failure (24.5% vs. 12.1%) and renal failure (33.8% vs. 17.3%) in comparison to those without diabetes. The most prevalent diabetes medications received in hospital were metformin (43%), DPP4 inhibitors (22.7%) and sulfonylureas (18.8%). The most common reason for admission among patients with diabetes was heart failure (9.0%), and among patients without diabetes was pneumonia (7.8%). Median length of stay was longer for patients with diabetes (5.5 vs. 4.5 days) and in-hospital mortality was similar between groups (6.8% with diabetes vs. 6.5% without diabetes).
Diabetes is one of the most prevalent chronic medical conditions, affecting roughly one third of all patients hospitalized on an internal medicine ward and is associated with other comorbidities and longer hospital stays. ICD-10-CA codes were highly accurate in identifying patients with diabetes. The development of an inpatient cohort will allow for further study of in-hospital practices and outcomes among patients with diabetes.
在加拿大，每七个成年人中就有一人患有糖尿病（即 230 万人），到 65 岁时，患糖尿病的终身风险约为 30%。尽管住院的患者中有 30%患有糖尿病，但加拿大和全球都缺乏糖尿病患者住院的住院数据。
验证国际疾病分类第十版加拿大版（ICD-10-CA）代码，以识别糖尿病患者，创建安大略省内科住院患者的多中心数据库，并确定他们的基线特征、药物使用和入院特征。
我们创建了一个数据库，其中包含在安大略省 8 家参与一般内科住院倡议（GEMINI）医院数据共享网络的医院于 2010 年至 2020 年期间住院的糖尿病患者。使用图表审查根据以下任何一种方法确定患有糖尿病的患者：（i）先前医生诊断为糖尿病，（ii）记录的血红蛋白 A1c≥6.5%，或（iii）住院前开具的糖尿病药物处方。评估了 ICD-10-CA 糖尿病代码的测试特征。我们比较了有和没有糖尿病的患者的基线人口统计学、药物使用和住院详细信息。对于住院详细信息，我们收集了入院诊断、合并症指数、住院时间、是否接受 ICU 级护理以及住院死亡率等信息。
在总研究队列中，共有 384588 次入院，其中 118987 次（30.9%）的 ICD-10-CA 诊断代码为糖尿病（E10.x、E11.x、E13.x、E14.x）。ICD-10-CA 诊断代码的灵敏度和特异性分别为 95.9%和 98.8%。大多数患有 ICD-10-CA 糖尿病代码的患者都有 2 型糖尿病代码（93.9%），而 1 型糖尿病代码很少见（6.1%）。无糖尿病患者的平均年龄为 66.4 岁，而有 ICD-10-CA 糖尿病诊断代码的患者的平均年龄为 71.3 岁。与没有糖尿病的患者相比，患有糖尿病的患者高血压（64%比 37.9%）、冠状动脉疾病（28.7%比 15.3%）、心力衰竭（24.5%比 12.1%）和肾衰竭（33.8%比 17.3%）的患病率更高。在医院接受的最常见的糖尿病药物是二甲双胍（43%）、DPP4 抑制剂（22.7%）和磺酰脲类（18.8%）。患有糖尿病的患者最常见的入院原因是心力衰竭（9.0%），而没有糖尿病的患者最常见的入院原因是肺炎（7.8%）。患有糖尿病的患者住院时间中位数较长（5.5 天比 4.5 天），两组住院死亡率相似（6.8%患有糖尿病比 6.5%没有糖尿病）。
糖尿病是最常见的慢性疾病之一，约占内科病房住院患者的三分之一，与其他合并症和更长的住院时间有关。ICD-10-CA 代码在识别糖尿病患者方面非常准确。住院患者队列的建立将允许进一步研究糖尿病患者的住院实践和结果。
