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PTE 2006 Diabetes Specifications
Defining the Population: Practices should submit data on patients aged 18-
80 years old who meet the current American Diabetic Association criteria
for type 1 or type 2 diabetes are to be reported See ADA criteria below
In addition, please adhere to the following criteria:
Include all patients regardless of payer eg commercial, Medicare,
Medicaid, self-pay, uninsured, etc
Include only patients who are active members of your practice For
example:
a You are the assigned PCP eg HMO, PPO, MaineCare, etc or
b The patient has had 2 or more visits of any type to the practice
within the past 2 years, and there is no other PCP
c AND the patient has been continuously enrolled in your practice from
6/1/05 to 5/31/06
1 Exclusions:
a Patient has died
b Patient no longer receives care from the practice
c Patient receives their primary care predominantly from another
practice ie your practice only saw them for coverage of another
practice
d Patient has gestational diabetes only
2 May exclude:
a Patients in hospice or comfort measures only
b Patients with dementia
c Patients in Nursing
Home for whom you are no longer the PCP
d Patients in Nursing Home with life expectation of less than 2-5 years
e Patients with End Stage Renal Disease
3 Clinically verify that all the patients meet the ADA definition for
diabetes see below
Note:
Participating practices must report measures on all patients with
diabetes who were continuously enrolled in the practice from June 1, 2005
- May 31, 2006
Practices may choose to report measures on patients receiving care in the
practice for partial year if they wish to include these patients
In order to include tests that may have been done just beyond the 12-
month window June 1, 2005 - May 31, 2006, we will accept dates and
results of tests done in June and July as long as they can be submitted
by the due date of July 31
Suggested steps to find all eligible patients in practice for diabetes
reporting:
1 Find all patients with one or more office visits in past two years with
billing ICD-9 code of 250x diabetes eg in electronic billing
system; EMR; or electronic or paper registry, and/or
2 Find patients with two or more pharmacy claims for diabetes medications
NOTE: using HbA1c test to find
patients with diabetes is not
recommended, as this test is sometimes inappropriately done as a
screening test for diabetes
3 Clinical Staff verify that each patient found using these methods meets
ADA criteria listed below for the diagnosis of diabetes before inclusion
in patient sample
ADA Criteria for Diagnosis of Diabetes Mellitus:
1 Symptoms of diabetes plus casual plasma glucose PG concentration
greater than or equal to 200 mg/dl 111 mmol/l
Casual is defined as any time of day without regard to time since last
meal The classic symptoms of diabetes include polyuria, polydipsia,
and unexplained weight loss
OR
2 Fasting plasma glucose FPG greater than or equal to 126 mg/dl
7mmol/l
Fasting is defined as no caloric intake for at least 8 hours
OR
3 2-h Plasma glucose PG greater than or equal to 200 mg/dl 111 mmo/l
during an oral glucose tolerance test OGTT
The test should be performed as described by the World Health
Organization, using a glucose load containing the equivalent of 75 g
anhydrous glucose dissolved in water
NOTE:
In the absence of unequivocal hyperglycemia, in order to make a
diagnosis of diabetes mellitus, these criteria should be confirmed by
repeat testing on a different day
The OGTT is not recommended for routine clinical use, but may be
required in the evaluations of patients with IFG or when diabetes is
still suspected despite a normal FPG
The use of the hemoglobin A1c A1C for the diagnosis of diabetes is
not recommended at this time
From ADAs Clinical Practice Recommendations 2006
Source:kentuckydiabetes.net
