[ { "phenotype_id": "PH548", "phenotype_version_id": 1096, "name": "Microvascular Complications", "definition": "Data source: \n\nWe used the Clinical Practice Research Datalink (CPRD), a large primary care database that holds complete electronic patient records (including diagnoses, prescriptions and referrals) from participating family practices across the UK. A hierarchical clinical coding system (Read) is used to record the data. In July 2012, data were available for 644 practices and 13,772,992 patients. Full details of the database have been provided elsewhere.\n\n\nDiabetes cohort:\n\nWe extracted data from 1 April 2006 to 31 March 2012 and, for ease of reporting and analysing, aggregated information into six financial years. Within each year, practice inclusion eligibility was determined by a CPRD assessment algorithm, which informs on practices considered to be of research standard; therefore, our cohort of practices varied over time. For each research standard practice and year, we defined as eligible patients those who were registered with the practice for the full year and were aged 18 years or over in that year. From these patients, using relevant Read codes for type 2 diabetes (e.g. C10F.00: Type 2 diabetes mellitus) and excluding those treated with insulin within 2 years of diagnosis, we identified 246,544 patients over the study period. Diagnoses were not constrained to the study period and a relevant code prior to the study as well as during the study period would flag a patient from the respective year onwards. Data on sex, age and removal from the database due to deaths were available and complete for all patients.We extracted data on diabetes-related macrovascular (myocardial infarction, stroke, peripheral vascular disease or amputation) and microvascular (retinopathy, neuropathy, nephropathy [chronic kidney disease stages 4–5] or foot ulcer) complications as well as comorbidities (asthma, coronary heart disease, chronic kidney disease [excluded from microvascular analysis], chronic obstructive pulmonary disease, depression, dementia, severe mental illness, heart failure, hypertension, stroke [excluded from macrovascular analysis], cancer, epilepsy, osteoarthritis, osteoporosis and hypothyroidism). Although we aimed to include all conditions associated with diabetes, the choice was partially determined by the domains incentivised under the Quality and Outcomes Framework (QOF), for which accuracy of diagnosis is considered high. Information was also extracted on smoking (never smoked, current, exsmoker and missing data),BMI, HbA1c levels (%), cholesterol levels (mmol/l) and systolic/diastolic BP (mmHg). Biometric measurement data were cleaned and we calculated patient means for each year when more than one relevant record was available. Using product lists we determined prescription prevalence (at least one) for relevant medications: ACE inhibitors, acarbose, α-blockers, anticoagulants, antiplatelet agents, β-blockers, calcium-channel blockers, thiazide diuretics, loop diuretics, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide- 1 agonists, statins and other lipid-lowering drugs, meglitinides , metformin, sulfonylureas and thiazolidinediones. For approximately 60% of the practices, records were linked to Office of National Statistics (ONS) mortality data and we had access to death dates for all their patients. For these, using ICD-10 codes (www.who.int/classifications/icd/en/) we were able to estimate deathslinked to specific causes (underlying or in the top three): diabetes (E10–E16), ischaemic heart disease (I21–I22), stroke (I60–I64) or stroke excluding bleeds (excluding I63).\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Evangelos Kontopantelis, David A Springate, David Reeves, Darren M. Aschroff, Martin Rutter, Iain Buchan, Tim Doran, Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia, 58:505-518, 2015. " } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:24:30.406673Z", "author": "Evangelos Kontopantelis, David A Springate, David Reeves, Darren M. Aschroff, Martin Rutter, Iain Buchan, Tim Doran, Matthias Pierce, Darren M. Ashcroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:24:30.406701Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/04/2006 - 31/03/2012", "concept_information": [ { "concept_id": 1939, "concept_version_id": 5016, "concept_name": "Microvascular Complications - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH548", "phenotype_version_id": 1096, "phenotype_name": "Microvascular Complications", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "1Z13.00", "description": "Chronic kidney disease stage 4", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z14.00", "description": "Chronic kidney disease stage 5", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1H.00", "description": "Chronic kidney disease stage 4 with proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1H.11", "description": "CKD stage 4 with proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1J.00", "description": "Chronic kidney disease stage 4 without proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1J.11", "description": "CKD stage 4 without proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1K.00", "description": "Chronic kidney disease stage 5 with proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1K.11", "description": "CKD stage 5 with proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1L.00", "description": "Chronic kidney disease stage 5 without proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1Z1L.11", "description": "CKD stage 5 without proteinuria", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBa.00", "description": "O/E- non-referable retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBk.00", "description": "O/E - right eye stable treated prolif diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBl.00", "description": "O/E - left eye stable treated prolif diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBo.00", "description": "O/E - sight threatening diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBP.00", "description": "O/E - right eye background diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBQ.00", "description": "O/E - left eye background diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBr.00", "description": "Impaired vision due to diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBR.00", "description": "O/E - right eye preproliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBS.00", "description": "O/E - left eye preproliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBT.00", "description": "O/E - right eye proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBV.00", "description": "O/E - left eye proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "2BBY.00", "description": "O/E - referable retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C104.11", "description": "Diabetic nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C104z00", "description": "Diabetes mellitus with nephropathy NOS", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C106.12", "description": "Diabetes mellitus with neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C106.13", "description": "Diabetes mellitus with polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C108D00", "description": "Insulin dependent diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109600", "description": "Non-insulin-dependent diabetes mellitus with retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109611", "description": "Type II diabetes mellitus with retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109612", "description": "Type 2 diabetes mellitus with retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109A00", "description": "Non-insulin dependent diabetes mellitus with mononeuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109A11", "description": "Type II diabetes mellitus with mononeuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109B00", "description": "Non-insulin dependent diabetes mellitus with polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109B11", "description": "Type II diabetes mellitus with polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109C00", "description": "Non-insulin dependent diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109C11", "description": "Type II diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109C12", "description": "Type 2 diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109H00", "description": "Non-insulin dependent d m with neuropathic arthropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109H11", "description": "Type II diabetes mellitus with neuropathic arthropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C109H12", "description": "Type 2 diabetes mellitus with neuropathic arthropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10F600", "description": "Type 2 diabetes mellitus with retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10F611", "description": "Type II diabetes mellitus with retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FA00", "description": "Type 2 diabetes mellitus with mononeuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FA11", "description": "Type II diabetes mellitus with mononeuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FB00", "description": "Type 2 diabetes mellitus with polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FB11", "description": "Type II diabetes mellitus with polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FC00", "description": "Type 2 diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FC11", "description": "Type II diabetes mellitus with nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "C10FH00", "description": "Type 2 diabetes mellitus with neuropathic arthropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F171100", "description": "Autonomic neuropathy due to diabetes", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F171z00", "description": "Peripheral autonomic neuropathy due to disease NOS", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F366.00", "description": "Polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F367.00", "description": "Peripheral neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372.00", "description": "Polyneuropathy in diabetes", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372000", "description": "Acute painful diabetic neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372100", "description": "Chronic painful diabetic neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372.11", "description": "Diabetic polyneuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372.12", "description": "Diabetic neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F372200", "description": "Asymptomatic diabetic neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F374z00", "description": "Polyneuropathy in disease NOS", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F37y100", "description": "Axonal sensorimotor neuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F37z.11", "description": "Polyneuropathy unspecified", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F3y0.00", "description": "Diabetic mononeuropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420.00", "description": "Diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420000", "description": "Background diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420100", "description": "Proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420200", "description": "Preproliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420600", "description": "Non proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420700", "description": "High risk proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420800", "description": "High risk non proliferative diabetic retinopathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F420z00", "description": "Diabetic retinopathy NOS", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "F422z00", "description": "Proliferative retinopathy NOS", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Fyu6B00", "description": "[X]Other mononeuropathies of lower limb", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Fyu7C00", "description": "[X] Polyneuropathy, unspecified", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "FyuAC00", "description": "[X]Autonomic neuropathy/endocrine+metabolic diseases CE", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K02..12", "description": "Nephropathy - chronic", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K03..00", "description": "Nephritis and nephropathy unspecified", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K03..11", "description": "Nephritis and nephropathy unspecified", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K03..12", "description": "Nephropathy, unspecified", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K054.00", "description": "Chronic kidney disease stage 4", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K055.00", "description": "Chronic kidney disease stage 5", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "K08yA00", "description": "Proteinuric diabetic nephropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "N035.00", "description": "Neuropathic arthropathy", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "N242300", "description": "Neuropathic pain", "attributes": { "Entity type": "microvascular_complications", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/0t92-8q22", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1096, "version_name": "Microvascular Complications", "version_date": "2021-10-06T16:24:30.434824Z", "is_published": true, "is_latest": true } ] } ]