DM006 - Diabetes (with nephropathy or micro-albuminuria) on ACEi or ARB

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID	Description
DM006	The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE-I (or ARBs).

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the DM006 denominator if:

1. they are on the Diabetes register
   
2. they have a proteinuria or microalbuminuria code
   

It is worth reviewing patients in the eligible population as often there may be a one off inaccurate code which has inadvertently added the patient to the denominator for this indicator

How to achieve the indicator

To meet the criteria for DM006, eligible patients must have had:

1. an ACE inhibitor or ARB prescription issued within 6 months of the end of the contract year

What will remove patients from eligibility?

1. Patients for whom diabetes quality indicator care was unsuitable in the contract year
2. Patients who meet at least one of the criteria from Group 1 and at least 1 of the criteria from Group 2:
1. Group 1
   

1. a persisting contraindication to an ACE inhibitor anywhere in their record (or)
   

2. an expiring contraindication to an ACE inhibitor recorded in the contract year (or)
   

3. have chosen not to receive an ACE inhibitor in the contract year

2. Group 2
   

1. a persisting contraindication to an ARB anywhere in their record (or)
   

2. an expiring contraindication to an ARB recorded in the contract year (or)
   

3. have chosen not to receive an ARB in the contract year

3. Patients who have chosen not to receive diabetes quality indicator care in the contract year
4. Patients who have been invited twice (at least 7 days apart) for review
   
5. Patients who were diagnosed with diabetes in the last 3 months of the contract year
   
6. Patients who were newly registered with the practice in the last 3 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Codes for proteinuria (PRT_COD)

SNOMED code	SNOMED code description
12178007	Nephrogenous proteinuria
12511000132108	Persistent proteinuria
157141000119108	Proteinuria due to type 2 diabetes mellitus
197716006	Isolated proteinuria with specified morphological lesion
197717002	Isolated proteinuria with specified morphological lesion, minor glomerular abnormality
197719004	Isolated proteinuria with specified morphological lesion, focal and segmental glomerular lesions
197720005	Isolated proteinuria with specified morphological lesion, diffuse membranous glomerulonephritis
197721009	Isolated proteinuria with specified morphological lesion, diffuse mesangial proliferative glomerulonephritis
197722002	Isolated proteinuria with specified morphological lesion, diffuse endocapillary proliferative glomerulonephritis
197723007	Isolated proteinuria with specified morphological lesion, diffuse mesangiocapillary glomerulonephritis
197724001	Isolated proteinuria with specified morphological lesion, dense deposit disease
197725000	Isolated proteinuria with specified morphological lesion, diffuse concentric glomerulonephritis
231860006	Proteinuria of undiagnosed cause
236500003	Proteinuric nephropathy due to diabetes mellitus
236720004	Asymptomatic proteinuria
243421000119104	Proteinuria due to type 1 diabetes mellitus
264867001	Nephrotic range proteinuria
2740001	Gouty proteinuria
274769005	Albuminuria
29738008	Proteinuria
324251000000105	Chronic kidney disease stage 3 with proteinuria
324311000000101	Chronic kidney disease stage 3A with proteinuria
324371000000106	Chronic kidney disease stage 3B with proteinuria
324441000000106	Chronic kidney disease stage 4 with proteinuria
324501000000107	Chronic kidney disease stage 5 with proteinuria
34993002	Mixed proteinuria
35727008	Cardiac proteinuria
368931000119104	Isolated proteinuria co-occurrent and due to membranoproliferative glomerulonephritis type III
420514000	Persistent proteinuria due to type 1 diabetes mellitus
421986006	Persistent proteinuria due to type 2 diabetes mellitus
445170001	Macroalbuminuric nephropathy due to diabetes mellitus
61135002	Residual proteinuria
735624002	Grade A3 albuminuria
89238002	True proteinuria
949921000000100	Chronic kidney disease with glomerular filtration rate category G3a and albuminuria category A3
950101000000101	Chronic kidney disease with glomerular filtration rate category G3b and albuminuria category A3
950231000000104	Chronic kidney disease with glomerular filtration rate category G4 and albuminuria category A3
950311000000102	Chronic kidney disease with glomerular filtration rate category G5 and albuminuria category A3

Codes for microalbuminuria (MAL_COD)

SNOMED code	SNOMED code description
18521000119106	Microalbuminuria due to type 1 diabetes mellitus
236499007	Microalbuminuric nephropathy due to diabetes mellitus
312975006	Microalbuminuria
401110002	Type 1 diabetes mellitus with persistent microalbuminuria
420715001	Persistent microalbuminuria due to type 2 diabetes mellitus
421305000	Persistent microalbuminuria due to type 1 diabetes mellitus
90781000119102	Microalbuminuria due to type 2 diabetes mellitus

Angiotensin-converting enzyme (ACE) inhibitor contraindications (persisting) (XACE_COD)

SNOMED code	SNOMED code description
18321000122100	Non-allergic hypersensitivity to benazepril
18361000122109	Non-allergic hypersensitivity to moexipril
18401000122101	Non-allergic hypersensitivity to imidapril
293500009	Angiotensin-converting-enzyme inhibitor adverse reaction
293501008	Captopril adverse reaction
293502001	Lisinopril adverse reaction
293503006	Quinapril adverse reaction
293504000	Ramipril adverse reaction
293505004	Cilazapril adverse reaction
293506003	Trandolapril adverse reaction
293507007	Enalapril adverse reaction
293508002	Fosinopril adverse reaction
293509005	Perindopril adverse reaction
371627004	Angiotensin converting enzyme inhibitor-aggravated angioedema
422593004	Acute renal failure caused by angiotensin-converting-enzyme inhibitor
609537003	Non-allergic hypersensitivity to angiotensin-converting enzyme inhibitor
609538008	Non-allergic hypersensitivity to captopril
609539000	Non-allergic hypersensitivity to cilazapril
609540003	Non-allergic hypersensitivity to enalapril
609541004	Non-allergic hypersensitivity to fosinopril
609542006	Non-allergic hypersensitivity to lisinopril
609543001	Non-allergic hypersensitivity to perindopril
609544007	Non-allergic hypersensitivity to quinapril
609545008	Non-allergic hypersensitivity to ramipril
609546009	Non-allergic hypersensitivity to trandolapril
609550002	History of angiotensin converting enzyme inhibitor pseudoallergy

Angiotensin-converting enzyme (ACE) inhibitor contraindications (expiring) (TXACE_COD)

SNOMED code	SNOMED code description
134390006	Angiotensin converting enzyme inhibitor not indicated
315364008	Angiotensin converting enzyme inhibitors contraindicated
407564000	Angiotensin converting enzyme inhibitor not tolerated

Angiotensin II receptor blockers (ARB) contraindications (persisting) (XAII_COD)

SNOMED code	SNOMED code description
293513003	Adverse reaction caused by losartan
407590002	Angiotensin II receptor antagonist adverse reaction
609534005	Non-allergic hypersensitivity to losartan
609549002	Non-allergic hypersensitivity to angiotensin II receptor antagonist
720672008	Adverse reaction caused by telmisartan
720673003	Adverse reaction caused by valsartan
720674009	Adverse reaction caused by olmesartan
720675005	Adverse reaction caused by irbesartan
720676006	Adverse reaction caused by eprosartan
720677002	Adverse reaction caused by candesartan
720678007	Adverse reaction caused by azilsartan

Angiotensin II receptor blockers (ARB) contraindications (expiring) (TXAII_COD)

SNOMED code	SNOMED code description
394987009	Angiotensin II receptor antagonists contraindicated
407565004	Angiotensin II receptor antagonist not tolerated
407572003	Angiotensin II receptor antagonist not indicated

Codes for diabetes quality indicator care unsuitable for patient (DMPCAPU_COD)

SNOMED code	SNOMED code description
717421000000100	Excepted from diabetes quality indicators - patient unsuitable

Codes indicating the patient has chosen not to receive angiotensin-converting enzyme (ACE) inhibitor (ACEDEC_COD)

SNOMED code	SNOMED code description
134397009	Angiotensin converting enzyme inhibitor declined

Codes indicating the patient has chosen not to receive angiotensin II receptor blockers (ARB) (AIIDEC_COD)

SNOMED code	SNOMED code description
401084003	Angiotensin II receptor antagonist declined

Codes indicating the patient has chosen not to receive diabetes quality indicator care (DMPCADEC_COD)

SNOMED code	SNOMED code description
716031000000106	Excepted from diabetes quality indicators - informed dissent

Invite for diabetes care review codes (DMINVITE_COD)

SNOMED code	SNOMED code description
1109921000000106	Quality and Outcomes Framework quality indicator-related care invitation
1110921000000100	Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation
143401000000102	Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation using preferred method of communication
705072004	Diabetes monitoring invitation by short message service text messaging
1066911000000100	Diabetes monitoring short message service text message first invitation
1066921000000106	Diabetes monitoring short message service text message second invitation
1066931000000108	Diabetes monitoring short message service text message third invitation
1083111000000108	Diabetes monitoring invitation email
185756006	Diabetes monitoring first letter
185757002	Diabetes monitoring second letter
185758007	Diabetes monitoring third letter
185759004	Diabetes monitoring verbal invite
185760009	Diabetes monitoring telephone invite
310425007	Diabetes monitoring invitation

• Related Articles

• HF003 - Heart Failure on ACEi or ARB

  The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF). Indicator definition Indicator ID Description HF003 In those patients with a diagnosis of heart failure due to left ...

• DM017 - Diabetes Mellitus register

  The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF). This indicator is protected in the contract year 2024/25 and will be paid at 2023/24 performance levels Indicator ...

• DM023 - Diabetes (with a history of CVD) on a statin

  The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF). Indicator definition Indicator ID Description DM023 The percentage of patients with diabetes, on the register, and a ...

• DM033 - Diabetes, not frail, with BP 140/90mmHg or less

  The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF). Indicator definition Indicator ID Description DM033 The percentage of patients with diabetes, on the register, without ...

• DM020 - Diabetes (without frailty) with HbA1c less than or equal to 58

  The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF). Indicator definition Indicator ID Description DM020 The percentage of patients with diabetes, on the register, without ...