The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR): Unique 1.4 M patient Electronic Health Record cohort

Healthc (Amst). 2020 Dec;8(4):100458. doi: 10.1016/j.hjdsi.2020.100458. Epub 2020 Oct 1.


Background: The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR) study uses a novel Electronic Health Record (EHR) data approach as a tool to assess the epidemiology of known and new risk factors for type 2 diabetes mellitus (T2DM) and study how prevention interventions affect progression to and onset of T2DM. We created an electronic cohort of 1.4 million patients having had at least 4 encounters with a healthcare organization for at least 24-months; were aged ≥18 years in 2010; and had no diabetes (i.e., T1DM or T2DM) at cohort entry or in the 12 months following entry. EHR data came from patients at nine healthcare organizations across the U.S. between January 1, 2010-December 31, 2016.

Results: Approximately 5.9% of the LEADR cohort (82,922 patients) developed T2DM, providing opportunities to explore longitudinal clinical care, medication use, risk factor trajectories, and diagnoses for these patients, compared with patients similarly matched prior to disease onset.

Conclusions: LEADR represents one of the largest EHR databases to have repurposed EHR data to examine patients' T2DM risk. This paper is first in a series demonstrating this novel approach to studying T2DM.

Implications: Chronic conditions that often take years to develop can be studied efficiently using EHR data in a retrospective design.

Level of evidence: While much is already known about T2DM risk, this EHR's cohort's 160 M data points for 1.4 M people over six years, provides opportunities to investigate new unique risk factors and evaluate research hypotheses where results could modify public health practice for preventing T2DM.

Keywords: Big data; Chronic disease; Diabetes mellitus; Electronic health records; Epidemiologic methods; Epidemiologic research design; Public health informatics; Public health practice.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology
  • Electronic Health Records / statistics & numerical data
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prediabetic State / diagnosis*
  • Prediabetic State / epidemiology
  • Prediabetic State / physiopathology
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Assessment / standards*
  • Risk Assessment / statistics & numerical data
  • Risk Factors