Misclassification in assessment of diabetogenic risk using electronic health records.
Misclassification in assessment of diabetogenic risk using electronic health records.
复制标题
DOI：
10.1002/pds.3656
复制
发表时间：
2014-08
影响因子：
2.6
通讯作者：
Delaney, Joseph A.
中科院分区：
文献类型：
--
作者：
Winterstein, Almut G.;Kubilis, Paul;Bird, Steve;Cooper-DeHoff, Rhonda M.;Nichols, Greg A.;Delaney, Joseph A.
关键词：
可疑的糖尿病效应或药物适应症可能会增加对糖尿病(DM)的检测，导致在评估糖尿病药物效果时产生测量偏差。我们试图评估电子健康记录数据在确定糖尿病风险方面的有效性。我们在回溯性队列设计中使用时间依赖的COX比例风险模型来评估抗高血压药、他汀类药物、非典型抗精神病药物和抗抑郁药物的使用与两个终点之间的关系：(I)DM发病定义为空腹血糖(BG)≥126 mg/dl，随机BG≥200 mg/dl，HbA1c≥7.0%，或抗糖尿病药物启动；以及(Ii)首次阴性DM试验。我们使用泊松回归来评估这些药物对DM检测率的影响。1997年至2010年在凯撒永久西北医院登记的年龄35-的患者进入队列，在≥后6个月首次BG试验阴性，没有明显的DM。所有药物类别不仅与DM发病有关，而且与首次BG试验阴性和DM检测率显著相关。抗精神病药物的糖尿病风险最大(调整后的危险比[HR]=1.73[1.44-2.08])，首次阴性测试的倾向最大(调整后的HR=1.87[1.74-2.01])，检测率最高(调整后的比率比=1.76[1.72-1.81])。虽然肾素-血管紧张素系统阻滞剂和钙通道阻滞剂在临床试验中没有显示出糖尿病的风险，但两者都与糖尿病(HR=1.19[1.12-1.26]和1.27[1.17-1.38])、血糖试验阴性(1.38[1.35-1.41]和1.24[1.20-1.28])以及检测比率增加(比率比=1.26[1.24-1.27]和1.27[1.25-1.28])相关。当使用依赖于一般实践中的DM检测的数据来评估糖尿病风险时，应谨慎使用。
Suspected diabetogenic effects or drug indication may increase testing for diabetes mellitus (DM), resulting in measurement bias when evaluating diabetogenic drug effects. We sought to evaluate the validity of electronic health record data in determining DM risk. We used time-dependent Cox proportional hazard models within a retrospective cohort design to assess associations between use of antihypertensives, statins, atypical antipsychotics, and antidepressants, and two endpoints: (i) DM onset defined as fasting blood glucose (BG) ≥126 mg/dl, random BG ≥200 mg/dl, HbA1c ≥7.0%, or antidiabetic drug initiation; and (ii) first negative DM test. We used Poisson regression to assess the influence of these drugs on DM testing rates. Patients aged 35–64 years enrolled in Kaiser Permanente Northwest between 1997 and 2010 entered the cohort at the first negative BG test after ≥6 months without manifest DM. All drug classes showed significant associations not only with DM onset but also with first negative BG test and with DM testing rates. Antipsychotics had the greatest diabetogenic risk (adjusted hazard ratio [HR] = 1.73 [1.44–2.08]), the greatest propensity for a first negative test (adjusted HR = 1.87 [1.74–2.01]), and the highest testing rate (adjusted rate ratio = 1.76 [1.72–1.81]. Although renin–angiotensin system blockers and calcium channel blockers have shown no diabetogenic risk in clinical trials, both were associated with DM (HR = 1.19 [1.12–1.26] and 1.27 [1.17–1.38]), a negative glucose test (1.38 [1.35–1.41] and 1.24 [1.20–1.28]), and increased testing rates (rate ratio = 1.26 [1.24–1.27] and 1.27 [1.25–1.28]). Caution should be used when diabetogenic risk is evaluated using data that rely on DM testing in general practice.
登录
查看更多内容
影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
影响因子：
3.7
作者：
Albaugh VL;Singareddy R;Mauger D;Lynch CJ
通讯作者：
Lynch CJ
影响因子：
5.3
作者：
Guo, Jeff J.;Keck, Paul E., Jr.;L'Italien, Gilbert J.
通讯作者：
L'Italien, Gilbert J.
影响因子：
2.8
作者：
Ma, Tsochiang;Chang, Mu-Hsin;Jong, Gwo-Ping
通讯作者：
Jong, Gwo-Ping
影响因子：
16.2
作者：
Gupta, Ajay K.;Dahlof, Bjorn;Poulter, N. R.
通讯作者：
Poulter, N. R.