{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:55:13Z","timestamp":1791363313069,"version":"4.3.1"},"reference-count":51,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Hospital discharge data are increasingly reused for research and within health data spaces, but their value depends on accurate diagnostic coding. The validity of type 2 diabetes mellitus (T2DM) coding in the Spanish hospital discharge database (CMBD) had not been assessed across a whole regional network. We aimed to quantify the precision and completeness of E11 coding across the public hospital network of the Region of Madrid. Methods: We conducted a retrospective validation study in the public hospitals of the Region of Madrid (2016\u20132025). In each of four hospital complexity groups, we selected admissions with and without an ICD-10-ES E11 code, matched by age and sex (787 and 781 analysed). The reference standard was the American Diabetes Association criteria, checked in health records. Predictive values were estimated directly; sensitivity, specificity and prevalence were reconstructed for the whole population, adjusting for sex and age. Results: Of 4,707,924 discharges, 918,797 (19.5%) had a T2DM code. The positive predictive value was 94.2% (95% CI: 92.1\u201396.0), the negative predictive value 94.0% (91.3\u201396.3), specificity 98.5% (98.0\u201399.0) and sensitivity 79.3% (72.4\u201386.2), a lower bound. The estimated prevalence of T2DM among discharges was 23.2%, against 19.5% coded; about 226,000 admissions with T2DM had no code. Only the positive predictive value differed between hospital groups (p = 0.006). Conclusions: The E11 code is highly precise but incomplete: it is reliable for building cohorts, whereas counts based on it underestimate the number of cases by about one in five.<\/jats:p>","DOI":"10.3390\/jcm15197717","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:28:57Z","timestamp":1791361737000},"page":"7717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validating Type 2 Diabetes Diagnoses Across the Madrid Hospital Network: Evidence for Secondary Use of the CMBD in the European Health Data Space"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5982-4635","authenticated-orcid":false,"given":"Rafael","family":"G\u00f3mez-Coronado-Mart\u00edn","sequence":"first","affiliation":[{"name":"Servicio de Admisi\u00f3n y Documentaci\u00f3n Cl\u00ednica, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Department of Public Health and Maternal & Child Health, Universidad Complutense de Madrid, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4491-8898","authenticated-orcid":false,"given":"Ana","family":"Chac\u00f3n-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Servicio de Admisi\u00f3n y Documentaci\u00f3n Cl\u00ednica, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5551-5181","authenticated-orcid":false,"given":"Ana","family":"L\u00f3pez-de-Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Universidad Complutense de Madrid, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9450-4116","authenticated-orcid":false,"given":"Miguel A.","family":"Salinero-Fort","sequence":"additional","affiliation":[{"name":"Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute, 28029 Madrid, Spain"},{"name":"Research Network on Health Services and Chronic Diseases (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain"},{"name":"Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community Group\u2014Hospital La Paz Institute for Health Research IdiPAZ, 28046 Madrid, Spain"},{"name":"Community and Home Care Unit, Faculty of Biomedical and Health Sciences, Alfonso X El Sabio University, Villanueva de la Ca\u00f1ada, 28691 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniala L.","family":"Weir","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5417-6747","authenticated-orcid":false,"given":"Carmen de","family":"Burgos-Lunar","sequence":"additional","affiliation":[{"name":"Department of Public Health and Maternal & Child Health, Universidad Complutense de Madrid, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"},{"name":"Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute, 28029 Madrid, Spain"},{"name":"Servicio de Medicina Preventiva, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/EDE.0b013e31820f31e1","article-title":"Improving Automated Database Studies","volume":"22","author":"Ray","year":"2011","journal-title":"Epidemiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1055\/s-0034-1390027","article-title":"Administrative Database Studies: Goldmine or Goose Chase?","volume":"5","author":"Hashimoto","year":"2014","journal-title":"Evid.-Based Spine-Care J."},{"key":"ref_3","unstructured":"Agency for Healthcare Research and Quality (AHRQ) (2026, September 25). 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