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Validation of administrative and clinical case definitions for gestational diabetes mellitus against laboratory results
Author(s) -
Bowker S. L.,
Savu A.,
Donovan L. E.,
Johnson J. A.,
Kaul P.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13271
Subject(s) - medicine , gestational diabetes , diabetes mellitus , impaired glucose tolerance , population , pregnancy , gestational age , glucose tolerance test , obstetrics , outpatient clinic , diagnosis code , pediatrics , emergency medicine , gestation , type 2 diabetes , insulin resistance , endocrinology , genetics , environmental health , biology
Abstract Aim To examine the validity of International Classification of Disease, version 10 ( ICD ‐10) codes for gestational diabetes mellitus in administrative databases (outpatient and inpatient), and in a clinical perinatal database (Alberta Perinatal Health Program), using laboratory data as the ‘gold standard’. Methods Women aged 12–54 years with in‐hospital, singleton deliveries between 1 October 2008 and 31 March 2010 in Alberta, Canada were included in the study. A gestational diabetes diagnosis was defined in the laboratory data as ≥2 abnormal values on a 75‐g oral glucose tolerance test or a 50‐g glucose screen ≥10.3 mmol/l. Results Of 58 338 pregnancies, 2085 (3.6%) met gestational diabetes criteria based on laboratory data. The gestational diabetes rates in outpatient only, inpatient only, outpatient or inpatient combined, and Alberta Perinatal Health Program databases were 5.2% (3051), 4.8% (2791), 5.8% (3367) and 4.8% (2825), respectively. Although the outpatient or inpatient combined data achieved the highest sensitivity (92%) and specificity (97%), it was associated with a positive predictive value of only 57%. The majority of the false‐positives (78%), however, had one abnormal value on oral glucose tolerance test, corresponding to a diagnosis of impaired glucose tolerance in pregnancy. Conclusions The ICD ‐10 codes for gestational diabetes in administrative databases, especially when outpatient and inpatient databases are combined, can be used to reliably estimate the burden of the disease at the population level. Because impaired glucose tolerance in pregnancy and gestational diabetes may be managed similarly in clinical practice, impaired glucose tolerance in pregnancy is often coded as gestational diabetes.