Comprehensive Analysis, Surveillance, and Statistics Initiative for Diabetes in the Young (CASSIDY)

About This Grant

Diabetes affects greater than 38 million people in the U.S. Incidence of both type 1 and type 2 diabetes (T1D and T2D) has been increasing in youth. This increase will result in a growing population of young adults with diabetes. Diabetes is particularly burdensome in young individuals, as diabetes complications appear earlier for individuals with onset of disease in youth and young adulthood. Treatment options for diabetes have been rapidly evolving with the relatively recent approvals of glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-glucose contransporter-2 inhibitor (SGLT-2i) medications. The growing utilization of these medications has profound implications for public health and clinical medicine. Traditional forms of diabetes surveillance cannot provide the timely data needed to keep pace with the impact of these medications on the societal burden of diabetes and its complications. We will work with the Comprehensive Analysis, Surveillance, and Statistics Initiative in the Young (CASSIDY) network to develop an innovative electronic health record (EHR)- based strategy for conducting surveillance of diabetes, risk factors for complications, complications, and medication use among youth and young adults. The proposed research will use EHR data from two large health systems, Geisinger and University of Pittsburgh Medical Center (UPMC). Together, these health systems serve patients in all but four of 67 counties in Pennsylvania. This work will build on the methodology developed for the Assessing the Burden of Diabetes by Type in Children, Adolescents and Young Adults (DiCAYA) Network to achieve the following specific aims: 1. Estimate the incidence and prevalence of diabetes (type unspecified), T1D and T2D in youth (< 18 years) and young adults (18 to < 45 years) for more than sixty counties in Pennsylvania; 2. Ascertain the prevalence of risk factors for diabetes complications, occurrence of acute and chronic diabetes complications, and use of diabetes medications among youth and young adults with diabetes living in more than sixty counties; 3. Coordinate with other CASSIDY centers awardees and the CDC to conduct joint analyses of aggregate data of diabetes incidence and prevalence of diabetes, risk factors for complications, complications, and medication use among youth and young adults that are representative of the CASSIDY geographic catchment area. For this project, we will use the validated DiCAYA EHR computable phenotypes (CPs) for diabetes (type unspecified), T1D, and T2D. To estimate the prevalence of diabetes complications, we will use DiCAYA’s method of validation to create CPs for complications. We will use manual review of the medical record as the gold standard to determine the positive and negative predictive value, sensitivity, and specificity of CPs for complications. To assess medication use, we will triangulate three sources of data from the EHR: medication orders; medication reconciliation; and dispensing data from pharmacies. We will produce estimates by age, sex, race, ethnicity, insurance status, and geography. This information is essential to informing public health strategies and guiding allocation of resources.