Diabetes Metab J.  2023 Mar;47(2):201-210. 10.4093/dmj.2022.0375.

Comparison of Operational Definition of Type 2 Diabetes Mellitus Based on Data from Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey

• Baek JH
• Park YM
• Han KD
• Moon MK
• Choi JH
• Ko SH

• KMID: 2540517
• DOI: http://doi.org/10.4093/dmj.2022.0375

Abstract

Background
We evaluated the validity and reliability of the operational definition of type 2 diabetes mellitus (T2DM) based on the Korean National Health Insurance Service (NHIS) database.
Methods
Adult subjects (≥40 years old) included in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2017 were merged with those from the NHIS health check-up database, producing a cross-sectional dataset. We evaluated the sensitivity, specificity, accuracy, and agreement of the NHIS criteria for defining T2DM by comparing them with the KNHANES criteria as a standard reference.
Results
In the study population (n=13,006), two algorithms were devised to determine from the NHIS dataset whether the diagnostic claim codes for T2DM were accompanied by prescription codes for anti-diabetic drugs (algorithm 1) or not (algorithm 2). Using these algorithms, the prevalence of T2DM was 14.9% (n=1,942; algorithm 1) and 20.8% (n=2,707; algorithm 2). Good reliability in defining T2DM was observed for both algorithms (Kappa index, 0.73 [algorithm 1], 0.63 [algorithm 2]). However, the accuracy (0.93 vs. 0.89) and specificity (0.96 vs. 0.90) tended to be higher for algorithm 1 than for algorithm 2. The validity (accuracy, ranging from 0.91 to 0.95) and reliability (Kappa index, ranging from 0.68 to 0.78) of defining T2DM by NHIS criteria were independent of age, sex, socioeconomic status, and accompanied hypertension or dyslipidemia.
Conclusion
The operational definition of T2DM based on population-based NHIS claims data, including diagnostic codes and prescription codes, could be a valid tool to identify individuals with T2DM in the Korean population.

Keyword

Administrative claims, healthcare; Diabetes mellitus, type 2; Reproducibility of results

Figure

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  Fig. 1. Study diagram. KNHANES, Korea National Health and Nutrition Examination Survey; NHIS, National Health Insurance System; HbA1c, glycosylated hemoglobin; BMI, body mass index; CKD, chronic kidney disease. aSystolic blood pressure ≥140 mm Hg and/or diastolic pressure ≥90 mm Hg or on medication, bTotal cholesterol ≥240 mm Hg and/or on medication, cEstimated glomerular filtration rate <60 mL/min/1.73 m2.

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  Fig. 2. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and agreement according to the different algorithms of defining type 2 diabetes mellitus in Korean National Health Insurance System data. Algorithm 1: at least one of the following criteria was met: (1) fasting glucose ≥126 mg/dL or (2) International Classification of Disease, 10th Revision (ICD-10) codes corresponding to type 2 diabetes mellitus (E11-14) with accompanying prescription codes for any anti-diabetic drugs. Algorithm 2: at least one of the following criteria was met: (1) fasting glucose ≥126 mg/dL or (2) ICD-10 codes corresponding to type 2 diabetes mellitus (E11-14).

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