1

Call to order and role call

@Former user (Deleted)

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.

2

Conflicts of interest and agenda review

@Former user (Deleted)

None stated.

3

Combining diabetic complication with the type of diabetes

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.

4

Can one distinguish between a diabetic cataract and a senile cataract?

ALL

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.

5

Macula disorders

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.

6

Glaucoma and Diabetes Mellitus

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:

Given AK's involvement in the ophthalmology CRG and that the relationship between glaucoma and diabetes is not straight forward the group agreed to delegate the work of review to the OCRG.

Inactivate those concepts that include reference to the diabetes type.

7

Proliferative and non-proliferative retinopathy

ALL

Some of our group feel that these concepts are predominantly available to serve the purposes of the diabetic screening services and that from the perspective of day to day management of the diabetic patient they are less helpful. The intention is to discuss this in depth at our next meeting as part of the feedback from Eye Complications 2 but to introduce the topic now in preparation for the next meeting

Discussion:

Partially discussed as part of item 5 above.

Decision:

Carried forward for discussion at the next meeting.

9

AOB

ALL

No Further business discussed

10

Next meeting

ALL

Next conference call proposed in the first half of October on a Monday or Tuesday.