{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:52:27Z","timestamp":1761519147202,"version":"3.41.2"},"reference-count":39,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2016,5,2]]},"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with glycated hemoglobin (HbA1c) \u22657% (53\u2005mmol\/mol) while receiving 1\u20132 oral diabetes medications (ODMs) were identified from an EHR (2005\u20132011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c \u22657% (53\u2005mmol\/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4\u2005years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Sensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p&lt;0.001) and incident CVD (Kaplan-Meier estimates: 58%, 31%, 52%, and 54%, p=0.002) were greater in INS group after controlling for differences in baseline HbA1c (9.2\u00b12.0% vs 8.3\u00b11.2% vs 8.2\u00b11.3% vs 7.7\u00b11.1% (77 vs 67 vs 66 vs 61\u2005mmol\/mol), p&lt;0.001) and creatinine (1.15\u00b10.96 vs 1.10\u00b10.36 vs 1.01\u00b10.35 vs 1.07\u00b10.45\u2005mg\/dL, p=0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>An EHR can be an effective method for identifying prevalent and incident CVD in patients with T2D.<\/jats:p>\n               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