Diabetes mellitus


Parameter Case Report Form and Response Options

Does the patient suffer from diabetes? Yes No Unknown
Diabetes mellitus type 1
Diabetes mellitus type 2
Insulin treated type 2 diabetes mellitus
Secondary diabetes mellitus

This is an example of how the case report form could look like when such a data collection tool is used.


To integrate data from clinical care and research such as clinical trials, the guide relies on FHIR resources for data-exchange from the clinical and diagnostic healthcare process rather than constructing a plain questionnaire.

This profile of a FHIR Condition is derived from the Diagnosis-profile of the Medical Informatics Initiative (MII). The valueset bindings on the Condition.code element have been constrained to solely feature the response options for this particular parameter of the case report form. For the explicitly listed diseases in the case report form, the SNOMED and ICD codes are also explicitly specified in the ValueSets below. Note that for the 'Other' option the ValueSets contain filters that allow a number of other codes for this category that are included in the expansion.

A separate instance of a Condition resource is created for each of the requested diseases.

To represent the presence, absence or uncertainty of findings, use Condition.verificationStatus or uncertaintyOfPresence on Condition.modifierExtension. This is used to map the Yes/No/Unknown scheme from case report forms to the Condition resource. Note the additional constraint on Condition that checks if either verificationStatus or the extension is present:

keyseverityhumanexpression
unk-1errorIf verificationStatus is present, uncertaintyOfPresence-Extension SHALL NOT be present.verificationStatus.exists() != Condition.modifierExtension.where(url = 'https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence').exists()

Profile - Diabetes Mellitus

Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus

Snapshot

ReferenzPrimaerdiagnoseS I0..1Extension(Reference(Condition))
uncertaintyOfPresenceS ?! I0..1Extension(CodeableConcept)
identifierΣ0..*Identifier
clinicalStatusS Σ ?! I0..1CodeableConceptBinding
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
systemS Σ1..1uri
versionΣ0..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
severity0..1CodeableConceptBinding
Mehrfachcodierungs-KennzeichenS I0..1Extension(Coding)
SeitenlokalisationS I0..1Extension(Coding)
DiagnosesicherheitS I0..1Extension(Coding)
systemS Σ1..1uriFixed Value
versionS Σ1..1string
codeS Σ I1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemS Σ1..1uriFixed Value
versionΣ1..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
systemS Σ1..1uri
versionΣ0..1string
codeS Σ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
systemS Σ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
subjectS Σ I1..1MII-Reference(Patient | Group)
encounterS Σ I0..1MII-Reference(Encounter)
lebensphase-vonS I0..1Extension(CodeableConcept)
lebensphase-bisS I0..1Extension(CodeableConcept)
onsetDateTimeS Σ0..1dateTime
abatementDateTimedateTime
abatementAgeAge
abatementPeriodPeriod
abatementRangeRange
abatementStringstring
recordedDateS Σ1..1dateTime
recorderΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
summaryI0..1CodeableConcept
assessmentI0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
type0..1CodeableConcept
codeΣ I0..*CodeableConcept
detailΣ I0..*Reference(Resource)
noteS0..*Annotation


Extension - Uncertainty of Presence

Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence

Snapshot

extensionI0..0Extension
url1..1System.StringFixed Value
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1codeFixed Value
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string


ValueSets

Valuesets are provided with both SNOMED-CT and ICD-10-GM codes.


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/diabetes-mellitus-diseases

ValueSet 'DiabetesMellitusDiseases'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

Diabetes mellitus in the context of Covid-19

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • The following codes from system: SNOMED_CT

    CodeDisplay
    46635009Diabetes mellitus type 1 (disorder)
    44054006Diabetes mellitus type 2 (disorder)
    237599002Insulin treated type 2 diabetes mellitus (disorder)
    8801005Secondary diabetes mellitus (disorder)
  • Include codes from SNOMED_CT where concept IsA 73211009


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/diabetes-mellitus-diseases-icd

ValueSet 'DiabetesMellitusDiseasesICD'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

Diabetes mellitus in the context of Covid-19 from ICD-10-GM

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • The following codes from system: ICD10GM

    CodeDisplay
    E11.9Diabetes mellitus, Typ 2 : Ohne Komplikationen
    E10.9Diabetes mellitus, Typ 1 : Ohne Komplikationen
    E13.9Sonstiger näher bezeichneter Diabetes mellitus : Ohne Komplikationen
  • Include codes from ICD10GM where concept IsA E11Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E10Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E13Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E14Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E11Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E10Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E13Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E14Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E11Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E10Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E13Include codes from ICD10GM where child Exists false
  • Include codes from ICD10GM where concept IsA E14Include codes from ICD10GM where child Exists false


Examples

Diabetes mellitus present
Example condition that is confirmed present

{
    "resourceType": "Condition",
    "id": "diabetes-mellitus-present",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408475000",
                    "system": "http://snomed.info/sct",
                    "display": "Diabetic medicine"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "confirmed",
                "display": "Confirmed"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410605003",
                "display": "Confirmed present (qualifier value)"
            }
        ]
    },
    "clinicalStatus": {
        "coding":  [
            {
                "code": "active",
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "display": "Active"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "73211009",
                "system": "http://snomed.info/sct",
                "display": "Diabetes mellitus"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Diabetes mellitus type 1 absent
Example condition that is confirmed absent

{
    "resourceType": "Condition",
    "id": "diabetes-mellitus-type-i-absent",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408475000",
                    "system": "http://snomed.info/sct",
                    "display": "Diabetic medicine"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "refuted",
                "display": "Refuted"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410594000",
                "display": "Definitely NOT present (qualifier value)"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "46635009",
                "system": "http://snomed.info/sct",
                "display": "Diabetes mellitus type 1"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Diabetes mellitus type 2 present
Example condition that is confirmed present

{
    "resourceType": "Condition",
    "id": "diabetes-mellitus-type-ii-present",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408475000",
                    "system": "http://snomed.info/sct",
                    "display": "Diabetic medicine"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "confirmed",
                "display": "Confirmed"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410605003",
                "display": "Confirmed present (qualifier value)"
            }
        ]
    },
    "clinicalStatus": {
        "coding":  [
            {
                "code": "active",
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
                "display": "Active"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "44054006",
                "system": "http://snomed.info/sct",
                "display": "Diabetes mellitus type 2"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Insulin treated type 2 diabetes mellitus absent
Example condition that is confirmed absent

{
    "resourceType": "Condition",
    "id": "diabetes-mellitus-absent",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408475000",
                    "system": "http://snomed.info/sct",
                    "display": "Diabetic medicine"
                }
            ]
        }
    ],
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code": "refuted",
                "display": "Refuted"
            },
            {
                "system": "http://snomed.info/sct",
                "code": "410594000",
                "display": "Definitely NOT present (qualifier value)"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "code": "237599002",
                "system": "http://snomed.info/sct",
                "display": "Insulin treated type 2 diabetes mellitus"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}


Secondary diabetes mellitus unknown
Example condition where the presence is unknown

{
    "resourceType": "Condition",
    "id": "diabetes-mellitus-secondary-unknown",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/diabetes-mellitus"
        ]
    },
    "category":  [
        {
            "coding":  [
                {
                    "code": "408475000",
                    "system": "http://snomed.info/sct",
                    "display": "Diabetic medicine"
                }
            ]
        }
    ],
    "modifierExtension":  [
        {
            "url": "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/uncertainty-of-presence",
            "valueCodeableConcept": {
                "coding":  [
                    {
                        "system": "http://snomed.info/sct",
                        "code": "261665006",
                        "display": "Unknown (qualifier value)"
                    }
                ],
                "text": "Presence of condition is unknown."
            }
        }
    ],
    "code": {
        "coding":  [
            {
                "code": "8801005",
                "system": "http://snomed.info/sct",
                "display": "Secondary diabetes mellitus"
            }
        ]
    },
    "subject": {
        "reference": "Patient/gecco-patient"
    },
    "recordedDate": "2020-10-06"
}