Characterization of Symptoms and Symptom Clusters for Type 2 Diabetes Using a Large Nationwide Electronic Health Record Database

• Published in: Diabetes spectrum 2022-01, Vol.35 (2), p.159-170
• Main Authors: Brady, Veronica, Whisenant, Meagan, Wang, Xueying, Ly, Vi K, Zhu, Gen, Aguilar, David, Wu, Hulin
• Format: Article
• Language: English
• Subjects: Chronic illnesses; Diabetes; Diabetes mellitus (non-insulin dependent); Drowsiness; Electronic health records; Electronic medical records; Etiology; Phenotypes; Sleep and wakefulness; Symptom management
• ISSN: 1040-9165; 1944-7353
• DOI: 10.2337/ds21-0064

A variety of symptoms may be associated with type 2 diabetes and its complications. Symptoms in chronic diseases may be described in terms of prevalence, severity, and trajectory and often co-occur in groups, known as symptom clusters, which may be representative of a common etiology. The purpose of this study was to characterize type 2 diabetes-related symptoms using a large nationwide electronic health record (EHR) database. We acquired the Cerner Health Facts, a nationwide EHR database. The type 2 diabetes cohort ( = 1,136,301 patients) was identified using a rule-based phenotype method. A multistep procedure was then used to identify type 2 diabetes-related symptoms based on , 9th and 10th revisions, diagnosis codes. Type 2 diabetes-related symptoms and co-occurring symptom clusters, including their temporal patterns, were characterized based the longitudinal EHR data. Patients had a mean age of 61.4 years, 51.2% were female, and 70.0% were White. Among 1,136,301 patients, there were 8,008,276 occurrences of 59 symptoms. The most frequently reported symptoms included pain, heartburn, shortness of breath, fatigue, and swelling, which occurred in 21-60% of the patients. We also observed over-represented type 2 diabetes symptoms, including difficulty speaking, feeling confused, trouble remembering, weakness, and drowsiness/sleepiness. Some of these are rare and difficult to detect by traditional patient-reported outcomes studies. To the best of our knowledge, this is the first study to use a nationwide EHR database to characterize type 2 diabetes-related symptoms and their temporal patterns. Fifty-nine symptoms, including both over-represented and rare diabetes-related symptoms, were identified.