Open Access Highly Accessed Research article

A novel method for studying the temporal relationship between type 2 diabetes mellitus and cancer using the electronic medical record

Adedayo A Onitilo123*, Rachel V Stankowski2, Richard L Berg2, Jessica M Engel4, Gail M Williams3 and Suhail A Doi3

Author Affiliations

1 Department of Hematology/Oncology, Marshfield Clinic Weston Center, 3501 Cranberry Boulevard, Weston, WI 54476, USA

2 Marshfield Clinic Research Foundation, Marshfield, WI, USA

3 School of Population Health, University of Queensland, Brisbane, Australia

4 Department of Hematology/Oncology, Marshfield Clinic Cancer Care at St. Michael’s Hospital, Stevens Point, WI, USA

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BMC Medical Informatics and Decision Making 2014, 14:38  doi:10.1186/1472-6947-14-38

Published: 9 May 2014



We developed an algorithm for the identification of patients with type 2 diabetes and ascertainment of the date of diabetes onset for examination of the temporal relationship between diabetes and cancer using data in the electronic medical record (EMR).


The Marshfield Clinic EMR was searched for patients who developed type 2 diabetes between January 1, 1995 and December 31, 2009 using a combination of diagnostic codes and laboratory data. Subjects without diabetes were also identified and matched to subjects with diabetes by age, gender, smoking history, residence, and date of diabetes onset/reference date.


The final cohort consisted of 11,236 subjects with and 54,365 subjects without diabetes. Stringent requirements for laboratory values resulted in a decrease in the number of potential subjects by nearly 70%. Mean observation time in the EMR was similar for both groups with 13—14 years before and 5–7 years after the reference date. The two cohorts were largely similar except that BMI and frequency of healthcare encounters were greater in subjects with diabetes.


The cohort described here will be useful for the examination of the temporal relationship between diabetes and cancer and is unique in that it allows for determination of the date of diabetes onset with reasonable accuracy.

Type 2 diabetes mellitus; Cancer; Pre-diabetes; Electronic medical record; Method