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6-monthly Characteristics, Clinical/Provider Form

1 forms  
Patient ID
Description

Patient ID

Alias
UMLS CUI-1
C1269815
Indicate the patient's medical record number.
Description

This item is not in the original standard set, but appears in the ones created before it. To be able to assign the separate forms to a specific patient (in case of multiple patients per site) it is included here as well. (This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution. INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution)

Data type

integer

Alias
UMLS CUI [1]
C1269815
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
Description

This Item does not exist in the original standard set, instead it is asked to do the following: Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. For example, VARIABLEID_BASE (baseline); VARIABLEID_6MO (6 month follow-up); VARIABLEID_1YR (1 year follow-up), etc.

Data type

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Clinician Reported Outcomes: Glycemic Control
Description

Clinician Reported Outcomes: Glycemic Control

Alias
UMLS CUI-1
C0184788
UMLS CUI-2
C0205210
UMLS CUI-3
C0700287
UMLS CUI-4
C3267174
Provide the most recent HbA1c reading collected in the past 6 months
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider TYPE: Numerical RESPONSE OPTIONS: Numerical value of HbA1c

Data type

float

Alias
UMLS CUI [1,1]
C0019018
UMLS CUI [1,2]
C3267174
Units of HbA1c readings provided
Description

INCLUSION CRITERIA: All patients TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0019018
UMLS CUI [1,2]
C1519795
UMLS CUI [1,3]
C3267174
Provide the percentage of time in the range of 70 mg/dL – 180 mg/dL (3.9-10.0 mmol/L) over the past 6 months
Description

INCLUSION CRITERIA: Only persons with diabetes on continuous glucose monitoring TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider or Patient TYPE: Numerical RESPONSE OPTIONS: Numerical value of time in range

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C3267174
UMLS CUI [1,2]
C0040223
UMLS CUI [1,3]
C0086715
%
Clinician Reported Outcomes: Acute Events
Description

Clinician Reported Outcomes: Acute Events

Alias
UMLS CUI-1
C0184788
UMLS CUI-2
C0205210
UMLS CUI-3
C0700287
UMLS CUI-4
C0877248
Indicate if the person with diabetes experienced Diabetic Ketoacidosis or Hyperosmolar Hyperglycemic Syndrome in the past 6 months.
Description

Diabetic ketoacidosis includes euglycemic and hyperglycemic ketoacidosis. INCLUSION CRITERIA: All patients TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0220982
UMLS CUI [2]
C3888846
In the past 6 months, how many episodes of severe hypoglycemia requiring assistance from another person did the person with diabetes experience (this includes assistance from clinical and non-clinical individuals)?
Description

Level 3 hypoglycemia is defined as a hypoglycemic event needing assistance INCLUSION CRITERIA: All patients TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider or Patient TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0020615
UMLS CUI [1,2]
C4330815
UMLS CUI [1,3]
C0449788
In the past 6 months, how many episodes of level 2 hypoglycemia (Blood glucose below 54 mg/dl (3.0 mmol/L)) did the person with diabetes experience?
Description

Level 2 hypoglycemia is defined as a measurable glucose concentration <54 mg/dL (3.0 mmol/L) that needs immediate action INCLUSION CRITERIA: All patients TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider or Patient TYPE: Numerical

Data type

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0020615
UMLS CUI [1,3]
C3846732
Did any of these hypoglycemic episodes occur without symptoms?
Description

Level 2 hypoglycemia is defined as a measurable glucose concentration <54 mg/dL (3.0 mmol/L) that needs immediate action INCLUSION CRITERIA: If responded 1 or more to "In the past 6 months, how many episodes of level 2 hypoglycemia (Blood glucose below 54 mg/dl (3.0 mmol/L)) did the person with diabetes experience?" TIMING: Baseline, Every 6 months REPORTING SOURCE: Clinician /Healthcare provider or Patient TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0020615
UMLS CUI [1,2]
C3846732
UMLS CUI [1,3]
C0342317
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Similar models

6-monthly Characteristics, Clinical/Provider Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient ID
C1269815 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number.
integer
C1269815 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Clinician Reported Outcomes: Glycemic Control
C0184788 (UMLS CUI-1)
C0205210 (UMLS CUI-2)
C0700287 (UMLS CUI-3)
C3267174 (UMLS CUI-4)
Glycemic Control: HbA1c
Item
Provide the most recent HbA1c reading collected in the past 6 months
float
C0019018 (UMLS CUI [1,1])
C3267174 (UMLS CUI [1,2])
Item
Units of HbA1c readings provided
integer
C0019018 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
C3267174 (UMLS CUI [1,3])
Glycemic Control: Units of HbA1c
Code List
Units of HbA1c readings provided
CL Item
mmol/mol (1)
C3829066 (UMLS CUI-1)
(Comment:en)
CL Item
% (2)
C0439165 (UMLS CUI-1)
(Comment:en)
Glycemic Control: Time in range
Item
Provide the percentage of time in the range of 70 mg/dL – 180 mg/dL (3.9-10.0 mmol/L) over the past 6 months
float
C3267174 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,3])
Item Group
Clinician Reported Outcomes: Acute Events
C0184788 (UMLS CUI-1)
C0205210 (UMLS CUI-2)
C0700287 (UMLS CUI-3)
C0877248 (UMLS CUI-4)
Item
Indicate if the person with diabetes experienced Diabetic Ketoacidosis or Hyperosmolar Hyperglycemic Syndrome in the past 6 months.
integer
C0220982 (UMLS CUI [1])
C3888846 (UMLS CUI [2])
Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome
Code List
Indicate if the person with diabetes experienced Diabetic Ketoacidosis or Hyperosmolar Hyperglycemic Syndrome in the past 6 months.
CL Item
Yes, experienced DKA (1)
C0011880 (UMLS CUI-1)
(Comment:en)
CL Item
Yes, experienced HHS (2)
C3888846 (UMLS CUI-1)
(Comment:en)
CL Item
Yes, experienced both (3)
C0011880 (UMLS CUI-1)
C3888846 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (99)
C0439673 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
Item
In the past 6 months, how many episodes of severe hypoglycemia requiring assistance from another person did the person with diabetes experience (this includes assistance from clinical and non-clinical individuals)?
integer
C0020615 (UMLS CUI [1,1])
C4330815 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,3])
Hypoglycemia - Level 3
Code List
In the past 6 months, how many episodes of severe hypoglycemia requiring assistance from another person did the person with diabetes experience (this includes assistance from clinical and non-clinical individuals)?
CL Item
0 (0)
C0549184 (UMLS CUI-1)
(Comment:en)
CL Item
1 (1)
C0585347 (UMLS CUI-1)
(Comment:en)
CL Item
2 (2)
C1948050 (UMLS CUI-1)
(Comment:en)
CL Item
more than 2 (3)
C0439093 (UMLS CUI-1)
C1948050 (UMLS CUI-2)
(Comment:en)
CL Item
Unknown (99)
C0439673 (UMLS CUI-1)
(Comment:en)
Hypoglycemia - Level 2
Item
In the past 6 months, how many episodes of level 2 hypoglycemia (Blood glucose below 54 mg/dl (3.0 mmol/L)) did the person with diabetes experience?
integer
C0449788 (UMLS CUI [1,1])
C0020615 (UMLS CUI [1,2])
C3846732 (UMLS CUI [1,3])
Item
Did any of these hypoglycemic episodes occur without symptoms?
integer
C0020615 (UMLS CUI [1,1])
C3846732 (UMLS CUI [1,2])
C0342317 (UMLS CUI [1,3])
Statin/Lipid Lowering Therapy
Code List
Did any of these hypoglycemic episodes occur without symptoms?
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (9)
C0439673 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
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