Family Practice Advance Access originally published online on May 16, 2007
Family Practice 2007 24(3):230-236; doi:10.1093/fampra/cmm018
Identifying people at risk for undiagnosed type 2 diabetes using the GP's electronic medical record
a Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen
b Department of General Practice, University Maastricht, Maastricht, the Netherlands. Correspondence to: Erwin P Klein Woolthuis, Department of General Practice, Radboud University Nijmegen Medical Centre, 117 HAG, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Email: e.kleinwoolthuis@hag.umcn.nl
Received 22 November 2005; Accepted 18 March 2007.
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Abstract |
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Background. Screening for type 2 diabetes is recommended in at-risk patients. The GP's electronic medical record (EMR) might be an attractive tool for identifying them.
Objective. To assess the value of the GP's EMR in identifying patients at risk for undiagnosed type 2 diabetes and the feasibility to use this information in usual care to initiate screening.
Methods. In 11 Dutch general practices (25 GPs), we performed an EMR-derived risk assessment in all patients aged 
45 and 
75 years, without known diabetes, identifying those at risk according to the American Diabetes Association recommendations. Patients with an EMR-derived risk or risk after additional risk assessment during regular consultation were invited for capillary fasting plasma glucose (FPG) measurement.
Results. Of 13 581 patients, 3858 (28%) had an EMR-based risk (hypertension, cardiovascular disease, lipid metabolism disorders and/or obesity). Additional risk assessment in those without an EMR-based risk showed that in 51%, greater than one risk factor was present, mainly family history (51.2%) and obesity (59%). Ninety per cent returned for the FPG measurement. In both groups, we found patients with an FPG exceeding the cut point for diabetes (5.9% versus 4.1%).
Conclusions. With additional risk assessment during consultation, the GP's EMR was valuable in identifying patients at risk for undiagnosed type 2 diabetes. It was feasible to use this information to initiate screening. At-risk patients were willing to take part in screening. Better registration of family history and obesity will improve the EMR as a tool for identifying at-risk patients in opportunistic screening in general practice.
Keywords. Diabetes, diagnostic tests, information technology, family medicine, patient record.
Klein Woolthuis EP, de Grauw WJC, van Gerwen WHEM, van den Hoogen HJM, van de Lisdonk EH, Metsemakers JFM and van Weel C. Identifying people at risk for undiagnosed type 2 diabetes using the GP's electronic medical record. Family Practice 2007; 24: 230–236.
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