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Diabetes Mellitus C002

Document
Last amended 
25 June 2020
Current RMA Instruments
Reasonable hypothesis SOP

48 of 2020

Balance of Probabilities SOP

49 of 2020

Changes from previous Instruments

SOP Bulletin 215

ICD Coding
  • ICD-9-CM Codes: 250
  • ICD-10-AM Codes: E10, E11, E12, E13, E14
Brief description

Diabetes mellitus is a metabolic disorder characterized by high blood sugar levels. Most cases of diabetes mellitus can be classified as either type 1 or type 2.  Type 1 diabetes (5 to 10% of cases) results from the destruction of insulin secreting cells in the pancreas.  Type 2 diabetes (90 to 95% of cases) is due to resistance to the action of insulin by target tissues +/- some deficiency of insulin production.  Most patients with type 2 diabetes are obese. 

Confirming the diagnosis

Diagnosis requires confirmation by blood testing, for either plasma glucose level or HbA1c level, as specified in the SOP definition.

The relevant medical specialist is an endocrinologist or general physician.  The diagnosis can be confirmed by a general practitioner.

There are factors in the SOP that apply only to type 1 or type 2 diabetes, so information on the type of diabetes is required to apply those factors.

Additional diagnoses that are covered by this SOP
  • drug-induced diabetes
  • gestational diabetes
  • insulin dependent diabetes mellitus
  • non-insulin dependent diabetes mellitus
  • type 1 diabetes mellitus
  • type 2 diabetes mellitus
  • juvenile type diabetes mellitus
  • adult-onset type diabetes mellitus
  • primary diabetes mellitus
  • secondary diabetes mellitus
Conditions not covered by SOP
  • diabetes insipidus#
  • impaired glucose tolerance - not a disease

# non-SOP condition

Clinical onset

Clinical onset will be when the diagnosis is first confirmed by blood testing.  This is a threshold diagnosis.  A glucose level that is elevated but below the threshold does not establish clinical onset.

Clinical worsening

The normal clinical course varies.  Type 2 diabetes may resolve with weight loss.  The more usual course is for slow progression of disease with the eventual development of complications or associated secondary diseases.