(050) Identifying Prediabetes Patients Using Administrative Claims Linked with Lab Data to Assess Progression To Type 2 Diabetes and Treatment Initiation Patterns

Background: Prediabetes is a condition where blood sugar levels are elevated, but not high enough to be diagnosed as type 2 diabetes (T2D). There is currently only one ICD-10-CM code (ICD) to identify prediabetes. It is uncertain whether this ICD alone accurately identifies prediabetes patients in claims.

Objectives: The primary objective is to explore the identification of prediabetes patients using claims data linked with hemoglobin A1C (HbA1c) lab results. The secondary objectives are to assess progression to T2D and to determine the proportions of patients who initiated diabetes medication before T2D diagnosis.

Methods: This US retrospective claims database study included de-identified patients with prediabetes selected from the Komodo Research Dataset linked to Komodo Lab Results and Quest lab data via MapEnhance from January 2017 to May 2023 (≥2 ICD separate-day diagnoses R73.03 or ≥1 lab record HbA1c 5.7–6.4%). The proportion of patients identified using the ICD and/or HbA1c result was evaluated. The index date was the date of the first qualifying ICD or HbA1c result for prediabetes. Continuous enrollment (1 year pre- and 3 years post-index) and no evidence of prior diabetes (no type 1 diabetes (T1D), T2D, or diabetes medications) was required to assess progression to T2D (≥2 ICD or ≥1 HbA1c>6.4%). Baseline characteristics for those who did not progress to T2D (NDM), progressed within 1 year (D1Y), and within 2 years (D2Y) were examined. Initiation of diabetes medication post-index and before T2D diagnosis was also assessed.

Results: Among 29,566,421 prediabetes patients identified, 21% and 65% were identified using ICD and HbA1c results alone, respectively. Among patients with continuous enrollment (1,471,888), 6.0% and 4.3% progressed to T2D during the first and second year post-diagnosis, respectively. Among the cohorts NDM, D1Y, and D2Y, respective mean age (years) and female distribution were 50.3, 54.6, 53.9 and 56.5%, 57.5%, 55.0%. During baseline, the mean Charlson Comorbidity Index (CCI) scores for the cohorts NDM, D1Y, and D2Y were 0.8, 1.4, and 1.2, respectively. The respective proportions of who initiated diabetes medications post index before T2D diagnosis were 5.6%, 12.5%, 18.2%.

Conclusions: The number of prediabetes patients identified was higher using lab data vs claims data alone, but highest when combined. Similar baseline characteristics among the cohorts (NDM, D1Y, D2Y) were observed except for greater adult (>18 years) composition for patients who progressed to T2D (70.2%, 79.9%, 78.9%) and higher disease burden for those who progressed to T2D. Fewer than 1 out of 5 prediabetes patients initiated diabetes medications before T2D diagnosis.