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docs: minor edits (mostly formatting) to changes vignette
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vignettes/changes.Rmd

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---
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title: "Changes to algorithm since original validation"
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title: "Changes to algorithm"
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output: rmarkdown::html_vignette
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bibliography: references.bib
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csl: vancouver.csl
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vignette: >
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%\VignetteIndexEntry{Rationale}
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%\VignetteIndexEntry{Changes to algorithm}
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%\VignetteEngine{knitr::rmarkdown}
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%\VignetteEncoding{UTF-8}
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---
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In this vignette, you'll find a description of the changes that have
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been made to the OSDC algorithm since its [original
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validation](https://doi.org/10.2147/CLEP.S407019). The algorithm has
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been implemented with these changes in the `osdc` package. In addition,
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potential changes that might be implemented in the `osdc` package in the
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future are described. When an update to the algorithm has been
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implemented, this vignette will also provide validation metrics for that
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version of the algorithm and track its validity across versions.
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validation](https://doi.org/10.2147/CLEP.S407019). The osdc package uses
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the latest changes to the algorithm. Potential changes to the algorithm,
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rather than the specific implementation and code details, that we might
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in the future will also be described in this vignette. We will also
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provide validation metrics here whenever we make a change, and track
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these validations over the different versions.
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## Changes since original validation
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## Specific changes
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1. Purchases of semaglutid, dapagliflozin or empagliflozin are no
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longer used, neither for inclusion events nor classification of
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### Since the original published validation (version 1)
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1. We don't use purchases of semaglutid, dapagliflozin or
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empagliflozin, neither for inclusion events nor classification of
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diabetes type (due to increasing use in treatment of non-diabetes).
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2. Diabetes type reclassification based on insulin purchases in the
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previous year is no longer used.
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2. We no longer use diabetes type reclassification based on insulin
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purchases in the previous year.
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## Validity
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Algorithm validity across versions. Reports `PPV`: *positive predictive
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value* and `Sens`: *sensitivity* overall and among cases with atypical
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age at onset of T1D (after age 40) and T2D (before age 40),
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respectively.
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- Paper:
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- T1D:
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- PPV: 0.943
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- Sens: 0.773
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- T1D \>40:
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- PPV: 0.708
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- Sens: 0.378
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- T2D:
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- PPV: 0.875
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- Sens: 0.944
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- T2D\<40:
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- PPV: 0.471
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- Sens: 0.863
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## Future potential changes
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Algorithm validity across versions. Reports `PPV` (*positive predictive
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value*) and `sensitivity` among cases with atypical age at onset of T1D
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(after age 40) and T2D (before age 40), respectively.
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| Version | Diabetes type | PPV | Sensitivity |
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|---------|---------------|-------|-------------|
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| 1 | T1D | 0.943 | 0.773 |
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| 1 | T1D \>40 yrs | 0.708 | 0.378 |
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| 1 | T2D | 0.875 | 0.944 |
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| 1 | T2D \<40 yrs | 0.471 | 0.863 |
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## Potential future changes
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1. Add support for using medical birth register to define pregnancies
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to censor gestational diabetes (GDM). This will allow for the
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to), and enable the extension of the window of valid dates of
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diagnosis to 1996 onward.
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2. Simplify logic defining pregnancy index dates to remove dependency
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on maternal care visits (if performance in validation allows)
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on maternal care visits (if performance in validation allows).
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3. Limit the historic scope of primary diagnoses used to evaluate
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majority of diabetes-specific diagnoses in type classification (e.g.
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only evaluate majority among the last five type-specific diabetes
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diagnoses)
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diagnoses).

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