Paul Amos

This meeting is being recorded to ensure that important discussion points are not missed in the minutes.  The recording will be available to the SNOMED International community.  

If a majority of participants object to recording, only written minutes will be available, otherwise, anyone objecting to recording is requested to exit the meeting.

Paul Amos

None stated.

ALL

Many of the existing concepts relating to complications due to diabetes include an association with a specific type of diabetes:

• 368151000119108 |Cataract due to drug induced diabetes mellitus (disorder)|
• 421920002 |Cataract of eye due to diabetes mellitus type 1 (disorder)|
• 420756003 |Cataract of eye due to diabetes mellitus type 2 (disorder)|

A number of the reviewers have suggested that the focus of the concept should be on the disorder and reference to the type of diabetes is redundant as the patient record should already have a record of this at the time of diagnosis.

See also KP Diabetes requests.xlsx

Discussion:

Combined concepts of the type 421920002 |Cataract of eye due to diabetes mellitus type 1 (disorder)| are expressing 3 facts about the patient, firstly that they have a cataract, second that they are diagnosed with Type 1 diabetes mellitus and thirdly that there is a causal relationship between the cataract and diabetes mellitus type 1.

The focus of the concepts representing complications that are due to diabetes is the complication itself and not the type of diabetes. A decision regarding the type of diabetes will already have been made and recorded within the patients record. Therefore, from a clinical management perspective it makes more sense to record these 2 disorders separately as they may/will require separate clinical management.

It is important to recognise and record the relationship between a disorder and its cause where that cause has been been proven to be due to and specific to another disorder. Therefore, we would recognise and wish to record that someone with diabetic retinopathy has a retinopathy which is clinically evidenced as being due to the diabetes. However, the only reason for recording the type of diabetes is if if there is a clinically identifiable difference between the retinopathy caused by diabetes mellitus type 1 and diabetes mellitus type 2.

Finally, there are some additional untoward effects from creating content that specifies a particular complication against each of the diabetes types; firstly, a significant increase in content (combinatorial explosion) e.g. for each complication that occurs in a single organ we would require more than 100 concepts rather than a single concept that relates a complication to diabetes irrespective of its type. Secondly, retrieval and analytics becomes more difficult as we no longer know whether the diagnosis of type of diabetes is represented within the complication or as a separated coded entry. What happens where the diabetes type differs between the record of the complication and the record of the initial diabetic diagnosis?

Decision:

1. The consensus of the group is that no further content relating to diabetic complications should reference a specific diabetes type unless there is convincing evidence that the diabetes type gives rise to specific complication variants.
2. The group recommends that existing content that relates to specific diabetes types is inactivated.

• Paul Amos to discuss internally how this can be progressed. 

Discussion:

There does not appear to be any evidence that a cataract in a diabetic has characteristics that are any different to those identified in a cataract associated with advancing years. There is evidence that supports the notion that cataracts may begin at an earlier age and/or progress more quickly in diabetics than in those who are not diabetics.

Decision:

Given that there is no evidence that cataracts are causally related to diabetes the consensus is that existing content should be inactivated as erroneous with a historical association to:

• 193570009 |Cataract (disorder)|
• 816120008 |Cataract of right eye (disorder)|
• 816119002 |Cataract of left eye (disorder)|

as appropriate.

ALL

Some of these concepts include adjectives:

• Advanced
• Clinically significant
• High-risk/Non-high-risk

Is it possible to define these in a way that supports interoperability?

Discussion:

Content within the Macular disorder and Proliferative and non-proliferative retinopathy sections are impacted by the use of these adjectives. While there is often a lack of consistency and/or vagueness in the definition of these adjectives there are some used in retinal screening and elsewhere that have reasonably well accepted definition.

Depending on the context some clinicians will record individual retinal findings whereas others may simply review a retinal photograph and grade it according the accepted protocol.

Decision:

The group will review existing content where adjectives have been used and identify those concepts that have an internationally agreed definition and those that do not, where possible providing references, for discussion at the next meeting.

• Paul Amosto collate the concepts and distribute to the group.

AK/ALL

Anthony Khawaja is a lead on the ophthalmology CRG and their first work item is to address Glaucoma. Recent work suggests that diabetes may even be protective for primary open glaucoma. However, neovascular, which may arise as a result of diabetes may lead to secondary open-angle or angle-closure glaucoma.

Decision:

• AK to keep the CDPG updated on the content relevant to diabetic complications.
• Paul Amos to offer to model the diabetic glaucoma content

• Paul Amos to arrange