title: Call for consistent coding in diabetes mellitus using the Royal College of General Practitioners and NHS pragmatic classification of diabetes.
abstract: BACKGROUND
  The prevalence of diabetes is increasing with growing levels of obesity and an aging population. New practical guidelines for diabetes provide an applicable classification. Inconsistent coding of diabetes hampers the use of computerised disease registers for quality improvement, and limits the monitoring of disease trends.
  
  
  OBJECTIVE
  To develop a consensus set of codes that should be used when recording diabetes diagnostic data.
  
  
  METHODS
  The consensus approach was hierarchical, with a preference for diagnostic/disorder codes, to define each type of diabetes and non-diabetic hyperglycaemia, which were listed as being completely, partially or not readily mapped to available codes. The practical classification divides diabetes into type 1 (T1DM), type 2 (T2DM), genetic, other, unclassified and non-diabetic fasting hyperglycaemia. We mapped the classification to Read version 2, Clinical Terms version 3 and SNOMED CT.
  
  
  RESULTS
  T1DM and T2DM were completely mapped to appropriate codes. However, in other areas only partial mapping is possible. Genetics is a fastmoving field and there were considerable gaps in the available labels for genetic conditions; what the classification calls 'other' the coding system labels 'secondary' diabetes. The biggest gap was the lack of a code for diabetes where the type of diabetes was uncertain. Notwithstanding these limitations we were able to develop a consensus list.
  
  
  CONCLUSIONS
  It is a challenge to develop codes that readily map to contemporary clinical concepts. However, clinicians should adopt the standard recommended codes; and audit the quality of their existing records.
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK. s.lusignan@surrey.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Khaled
authors.initials: K
authors.lastname: Sadek
authors.forename: Helen
authors.initials: H
authors.lastname: McDonald
authors.forename: Pete
authors.initials: P
authors.lastname: Horsfield
authors.forename: Norah Hassan
authors.initials: NH
authors.lastname: Sadek
authors.forename: Aumran
authors.initials: A
authors.lastname: Tahir
authors.forename: Terry
authors.initials: T
authors.lastname: Desombre
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D059019:Clinical Coding / Q000592:standards*; D003920:Diabetes Mellitus / Q000145:classification*; D004739:England; D006801:Humans; D006943:Hyperglycemia / Q000145:classification*; D013222:State Medicine / Q000592:standards; D039061:Systematized Nomenclature of Medicine