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I have a database of diabetic patients. Mostly 80 % are T2DM patients. Now I would like to identify the T2DM patients based on their conditions reported. I mean when patients visit hospital (diabetic specialist clinic), they report/record their conditions.

So I decided that I will use the disorders list CLICK HERE of Type 2 diabetes to identify patients who are diagnosed for T2DM

However, I see that few patients have conditions like below which aren't covered or included in disorders list?

 Gastroesophageal reflux disease
 Tinnitus
 Blood chemistry abnormal
 Gastroesophageal reflux disease without esophagitis
 Manifest vertical squint
 Nonulcer dyspepsia
 Chronic gastritis

and other patient has below two conditions

 sleep apnea
 obesity

Why are the above items missing in the disorders list? Aren't they called complications? Am I right to understand the above conditions have arisen due to T2DM? Because my data is from Diabetes specialist clinic? Am I missing something here?

complications are nothing but diseases arising out of the main condition (which is T2DM) in my case.

He has the above conditions because he was diagnosed with T2DM. It can't be due to any other reason right? I mean why does he have to visit Diabetic specialist clinic for above conditions if it's not related to T2DM

How can I address this scenario? Can you help?

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  • I answered based on the list of conditions/symptoms in your previous version of the question. So, would you mind mention those instead of these new ones, so the Q and A will match? – Jan Jan 27 '20 at 11:41
  • Actually for the previous version of patient data, I see that he has atleast one disorder from the shrimp list. But for the recent version conditions, these patients don't have even one of the disorders but only the above conditions. So how do I interpret these patients in case like this is my confusion. Hence updated the post – The Great Jan 27 '20 at 12:08
  • A common complication of diabetes is "gastroparesis" - which means slow gastric emptying because of damaged nerves. It is the gastroparesis that can cause "dyspepsia," "reflux" and "gastritis." Tinnitus is a symptom of an ear disease and may not be related to diabetes. – Jan Jan 27 '20 at 12:20
  • If "gastroparesis" is a common complication, why it isn't there in shrimp list? – The Great Jan 27 '20 at 12:23
  • Because, gastroparesis in diabetes results from the damage of the nerves, which is mentioned in Shrimp as "disorder of nervous system." So, the disorder of the nervous system is direct complication and gastroparesis would be then a complication of complication and they do not list it. Anyway, that Shrimp list still does not follow the rule of mentioning only direct complications strictly, so I would not overthink this, at this point. All these "lists" and "categorizations" of medical things you can see on various websites, may not be as "matematicaly" perfect as you might expect. – Jan Jan 27 '20 at 12:32
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Conditions listed in the Shrimp list are direct complications of diabetes type 2. For example, "coronary artery disease" results from 2 pathological processes in diabetes type 2 (hyperglycemia and dyslipidemia).

Coronary artery disease can result in congestive heart failure, but this is now a complication of coronary heart disease, not diabetes 2.

Angina pectoris and chest pain are not complications, but symptoms (a complication needs to be a condition), and these symptoms are from heart disease, not from diabetes.

Individuals with diabetes type 2 are at increased risk of infections, such as pneumonia, but not every infection will be then listed as a complication of diabetes. The Shrimp list does not mention any infection, because it's still not a direct result of diabetes, it's just from increased risk. Dyspnea is a symptom (not a condition) of pneumonia (not of diabetes).

And finally, any individual appearing in a diabetic clinic, can have a condition that is completely unrelated to diabetes and is not its complication, for example, essential hypertension and epidemic vertigo.

So, a complication is a direct consequence of a disease. If that complication results in another complication, the latter may not be considered as a complication of diabetes anymore. In practice, this may not be so matematicaly clean, but that's the principle.

Also, if you have a list of complications that are actual complications of diabetes in a certain individual, and you don't know he/she has diabetes, you can't just diagnose them backwards from complications. For example, coronary heart disease is not only a complication of diabetes, but also of high blood pressure, etc.

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  • Hi Jan, Thanks for your detailed response. Much helpful. upvoted. I understand you answered based on my old version of the question. But would it be possible to add info based on the recent version of the question. another quick question. Can symptom be recorded in a "condition" table of a EHR system? – The Great Jan 27 '20 at 12:13
  • Regarding this point And finally, any individual appearing in a diabetic clinic, can have a condition that is completely unrelated to diabetes and is not its complication, for example, essential hypertension and epidemic vertigo., can you help me understand this better? Why does a patient have to visit Diabetes specialist clinic if he/she doesn't have any condition related to diabetes? – The Great Jan 27 '20 at 12:18
  • Okay. But Am I right to understand that all patients with Diabetes (T2 or T1) will definitely have one of the disorders (from the shrimp list)? I understand your example regarding gastroparesis which is at the narrow level in my data. But the shrimp list is at high level. So all the T2DM patients will definitely have a disorder associated with T2DM irrespective of the other symptoms/conditions they have? – The Great Jan 27 '20 at 12:39
  • No, a patient with diabetes 1 or 2 may have zero complications from the Shrimp list and even no symptoms. In general, the risk of complications increases with the duration of diabetes. – Jan Jan 27 '20 at 12:42
  • Let us continue this discussion in chat. – The Great Jan 27 '20 at 12:42

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