Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults
Publication Date: September 2, 2016
Guideline Status
Guideline Status
This guideline has been retired by the Endocrine Society
Key Points
Key Points
Advances in the pharmacokinetics and pharmacodynamics of insulin products and in the methods of insulin delivery and glucose monitoring are geared toward improving glucose control, minimizing hypoglycemia, and improving quality of life. Two such advances are continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (RT-CGM).
Success of these devices and technologies is directly linked to the level to which people are educated, capable, and willing to use them.
This guideline attempts to assess all available data on existing and emerging technologies and procedures for improving glucose control for patients with diabetes.
Success of these devices and technologies is directly linked to the level to which people are educated, capable, and willing to use them.
This guideline attempts to assess all available data on existing and emerging technologies and procedures for improving glucose control for patients with diabetes.
Treatment
Treatment
Insulin Pump Therapy Without Sensor Augmentation
Endocrine Society (ES) recommends CSII over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1-M)
699
ES recommends CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. ( 1-L )
699
ES suggests CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2-L)
699
Insulin Pump Therapy in Type 2 Diabetes Mellitus
ES suggests CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2-L)
699
Insulin Pump Use in the Hospital
ES suggests that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures. (2-L)
699
Selection of Candidates for Insulin Pump Therapy
ES recommends that before prescribing CSII, clinicians perform a structured assessment of a patient’s mental and psychological status, prior adherence to diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits. ( 1-L )
699
Use of Bolus Calculators in Insulin Pump Therapy
ES suggests encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations. (2-L)
699
Real-Time Continuous Glucose Monitors in Adult Outpatients
ES recommends RT-CGM devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis. ( 1-H )
699
ES recommends RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis. ( 1-H )
699
Use of Continuous Glucose Monitoring in Adults With Type 2 Diabetes Mellitus
ES suggests short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels ≥7% and are willing and able to use the device. ( 2-L )
699
Education and Training on the Use of Continuous Subcutaneous Insulin Infusion and Continuous Glucose Monitoring
ES suggests that adults with T1DM and T2DM who use CSII and continuous glucose monitoring (CGM) receive education, training, and ongoing support to help achieve and maintain individualized glycemic goals. (UGPS)
699
Table 1. CSII—Considerations for Education and Training
| Patient |
|---|
| Collaborate with health care professional (HCP) overseeing CSII use and/or the multidisciplinary diabetes team by returning for follow-up. Participate in using data management resources to make adjustments to therapy and evaluate self-care behaviors. |
| Provider |
| Provide education as indicated to address deficiencies or when upgrading to new technology. |
| Assess CSII use and evaluate for the loss of ability to operate insulin pump due to cognitive, physical, or age-related changes; changes in insurance coverage; or changes in the healthcare provider managing CSII use. |
| Time periods to assess patient self-care behaviors and knowledge before initiating CSII, assess: |
| Glucose monitoring via self-monitoring blood glucose (SMBG) frequency, and/or CGM use defined by HCP to meet individualized glycemic goals. |
| Carbohydrate counting or another method of mealtime bolus determination. |
| Ability to operate CSII and make setting changes due to factors such as dexterity, vision impairment, mental health, or cognition—independently or with assistance from a designated care provider. |
| Infusion site health and selection. |
| DKA prevention and treatment. |
| Hypoglycemia—prevention, detection, and treatment. |
| Emergency supplies. |
| If using bolus calculator, assess these settings: insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets, and active insulin time. |
| Annually and/or when upgrading to a new CSII device, re-assess: |
| Glucose monitoring via SMBG frequency and/or CGM use defined by HCP to meet individualized glycemic goals. |
| Basal settings via basal rate testing across different time periods, adjust as indicated. |
| Bolus calculator settings, if using feature, adjust as indicated. |
| Infusion sites and type of infusion set, adjust as indicated. |
| Ability to troubleshoot insulin pump malfunction. |
| DKA prevention and treatment. |
| Hypoglycemia prevention, detection, and treatment. |
| Emergency supplies. |
| Back-up plan for use of injected insulin should pump fail. |
| When discontinuing CSII or transitioning to MDI, re-assess: |
| Glucose monitoring via SMBG frequency and/or CGM use defined by HCP to meet individualized glycemic goals. New insulin plan for MDI. |
Table 2. RT-CGM Technology—Considerations for Education and Training for Personal Use
| Patient |
|---|
| Collaborate with HCP overseeing RT-CGM use and/or the multidisciplinary diabetes team by returning for follow-up. |
| Participate in use of data management resources to make adjustments to therapy and evaluate self-care behaviors. |
| Provider |
| Provide education as indicated to address deficiencies or when upgrading to new CGM technology. |
| On an ongoing basis, assess CGM use and evaluate for the loss of ability to operate CGM system due to: cognitive, physical, or age-related changes; changes in insurance coverage; or changes in the healthcare provider managing CGM use. |
| Time periods to assess patient self-care behaviors and knowledge |
| Before initiating RT-CGM, assess: |
| Patient understanding that CGM does not replace SMBG. |
| Factors and self-care behaviors that may influence success with CGM. |
| When initiating RT-CGM, assess: |
| Knowledge of CGM system components—receiver, sensor, and transmitter. |
| Understanding of how CGM data differ from SMBG data. |
| Use of trend information based on changing glucose levels to adjust insulin doses. |
| Use of SMBG to calibrate CGM system. |
| Site selection and care. |
| Alarms (Check that alarms are set in a fashion to optimize patient benefit and minimize alarm fatigue. The initial focus is often on low alerts and falling blood glucose alarms. High alerts can be turned off or set well above target at first if patient is consistently high and doesn’t benefit from high alerts.) |
| Annually and/or when upgrading technology (for ongoing RT-CGM use), re-assess: |
| Ability to make insulin adjustment based on trend information. |
| Use of SMBG to calibrate. |
| Sensor site health and care. |
Table 3. Suggested Health Care Provider Resources to Support the Safe and Effective Use of CSII and RT-CGM
| Clinicians should implement a formalized educational plan for the initiation and long-term support of CSII and RT-CGM that is established by the practice setting. Clinicians should communicate education plans to potential candidates and individuals new to the practice setting. |
| Clinics should have a designated multidisciplinary diabetes team to evaluate potential candidates, initiate therapy and education, and to support long-term CSII and RT-CGM use that is part of the practice setting. Alternatively, a sole practitioner may also provide medical care and CSII education supported by other healthcare professionals or industry consultants as indicated. CSII and RT-CGM diabetes care team members could include the following health care providers: endocrinologist, advanced practice registered nurse, physician’s assistant, primary care provider, certified diabetes educator, registered dietitian with expertise in diabetes medical nutrition therapy, and mental health/behavioral therapists. |
| The clinical support staff or patient should know how to download data from glucose meters, insulin pumps, and RT-CGMs, and they should download data before an appointment in order to review data via print format, online secure patient pump portal, or the patient’s electronic health record. |
| Designated staff members (diabetes educators, medical assistants, or patient service representatives) should be available to help clinics obtain prior authorizations, schedule peer-to-peer reviews, submit supporting documents for determining coverage, answer insurance and distributor/third party vendor queries for additional documentation, and issue letters of support and/or appeal if therapy is declined. |
Recommendation Grading
Abbreviations
- CGM: Continuous Glucose Monitoring
- CSII: Continuous Subcutaneous Insulin Infusion
- DKA: Diabetes Ketoacidosis
- HCP: Health Care Professional
- MDI: Multiple Daily Injections
- RT-CGM: Real-time CGM
- SMBG: Self-monitoring Blood Glucose
- T1DM: Type 1 Diabetes Mellitus
- T2DM: Type 2 Diabetes Mellitus
Source Citation
Anne L. Peters, Andrew J. Ahmann, Tadej Battelino, Alison Evert, Irl B. Hirsch, M. Hassan Murad, William E. Winter, Howard Wolpert, Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 11, 1 November 2016, Pages 3922–3937, https://doi.org/10.1210/jc.2016-2534
Disclaimer
This resource is for informational purposes only, intended as a quick-reference tool based on the cited source guideline(s), and should not be used as a substitute for the independent professional judgment of healthcare providers. Practice guidelines are unable to account for every individual variation among patients or take the place of clinician judgment, and the ultimate decision concerning the propriety of any course of conduct must be made by healthcare providers after consideration of each individual patient situation. Guideline Central does not endorse any specific guideline(s) or guideline recommendations and has not independently verified the accuracy hereof. Any use of this resource or any other Guideline Central resources is strictly voluntary.
Codes
CPT Codes
| Code | Descriptor |
|---|---|
| 96170 | Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes |
| 96167 | Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes |
| 96156 | Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) |
| 98962 | Education and training for patient self-management by a qualified |
| 98961 | Education and training for patient self-management by a qualified |
| 96158 | Health behavior intervention, individual, face-to-face; initial 30 minutes |
| 99078 | Physician or other qualified health care professional qualified by education |
| 96159 | Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
| 98960 | Education and training for patient self-management by a qualified |
| 0592T | Health and well-being coaching face-to-face; individual |
| 96164 | Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes |
| 96168 | Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
| 0593T | Health and well-being coaching face-to-face; group (2 or more individuals) |
| 96165 | Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
| 0591T | Health and well-being coaching face-to-face; individual |
ICD-10 Codes
| Code | Descriptor | Documentation Concepts | Quality/Performance |
|---|---|---|---|
| E10.9 | Type 1 diabetes mellitus without complications | Type, caused by due to, complications or manifestations, laterality | |
| E09.3522 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3492 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.59 | Type 2 diabetes mellitus with other circulatory complications | Type, caused by due to, complications or manifestations, laterality | |
| E09.39 | Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication | Type, caused by due to, complications or manifestations, laterality | |
| E13.621 | Other specified diabetes mellitus with foot ulcer | Type, caused by due to, complications or manifestations, laterality | |
| E10.3312 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.628 | Type 1 diabetes mellitus with other skin complications | Type, caused by due to, complications or manifestations, laterality | |
| E11.628 | Type 2 diabetes mellitus with other skin complications | Type, caused by due to, complications or manifestations, laterality | |
| E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.43 | Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema | Type, caused by due to, complications or manifestations, laterality | |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | Type, caused by due to, complications or manifestations, laterality | |
| E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3553 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Type, caused by due to, complications or manifestations, laterality | |
| E09.42 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E13.37X2 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3559 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3512 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3543 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.59 | Diabetes mellitus due to underlying condition with other circulatory complications | Type, caused by due to, complications or manifestations, laterality | |
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication | Type, caused by due to, complications or manifestations, laterality | |
| E08.3532 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.3312 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E10.3522 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3492 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy | Type, caused by due to, complications or manifestations, laterality | |
| E10.3559 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3543 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.0 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | Type, complications/manifestations, due to/caused by, temporal factors | RXHCC30, HCC17 |
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma | Type, caused by due to, complications or manifestations, laterality | |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | Type, caused by due to, complications or manifestations, laterality | |
| E08.3549 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | Type, caused by due to, complications or manifestations, laterality | |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene | Type, caused by due to, complications or manifestations, laterality | |
| E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.37X1 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3519 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3411 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.59 | Drug or chemical induced diabetes mellitus with other circulatory complications | Type, caused by due to, complications or manifestations, laterality | |
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma | Type, caused by due to, complications or manifestations, laterality | |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | Type, caused by due to, complications or manifestations, laterality | |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.1 | Other specified diabetes mellitus with hyperosmolarity with coma | Type, complications/manifestations, due to/caused by, temporal factors | RXHCC30, HCC17 |
| E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.3542 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3391 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3299 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3319 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.69 | Other specified diabetes mellitus with other specified complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.3539 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3493 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.3523 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E09.22 | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease | Type, caused by due to, complications or manifestations, laterality | |
| E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3313 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3499 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3533 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.3299 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3513 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.3542 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3391 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3411 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.37X3 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.43 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3552 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.39 | Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.59 | Type 1 diabetes mellitus with other circulatory complications | Type, caused by due to, complications or manifestations, laterality | |
| E10.37X1 | Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema | Type, caused by due to, complications or manifestations, laterality | |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.3519 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease | Type, caused by due to, complications or manifestations, laterality | |
| E08.3529 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3591 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.65 | Other specified diabetes mellitus with hyperglycemia | Type, caused by due to, complications or manifestations, laterality | |
| E10.3313 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis | Type, caused by due to, complications or manifestations, laterality | |
| E10.3539 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3493 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.3523 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.630 | Diabetes mellitus due to underlying condition with periodontal disease | Type, caused by due to, complications or manifestations, laterality | |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.630 | Drug or chemical induced diabetes mellitus with periodontal disease | Type, caused by due to, complications or manifestations, laterality | |
| E10.8 | Type 1 diabetes mellitus with unspecified complications | Type, caused by due to, complications or manifestations, laterality | |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3532 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.622 | Type 1 diabetes mellitus with other skin ulcer | Type, caused by due to, complications or manifestations, laterality | |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer | Type, caused by due to, complications or manifestations, laterality | |
| E08.49 | Diabetes mellitus due to underlying condition with other diabetic neurological complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication | Type, caused by due to, complications or manifestations, laterality | |
| E08.3522 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication | Type, caused by due to, complications or manifestations, laterality | |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3559 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene | Type, caused by due to, complications or manifestations, laterality | |
| E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3512 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3549 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3553 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3292 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.69 | Type 2 diabetes mellitus with other specified complication | Type, caused by due to, complications or manifestations, laterality | |
| E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3492 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.29 | Drug or chemical induced diabetes mellitus with other diabetic kidney complication | Type, caused by due to, complications or manifestations, laterality | |
| E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.638 | Type 1 diabetes mellitus with other oral complications | Type, caused by due to, complications or manifestations, laterality | |
| E11.638 | Type 2 diabetes mellitus with other oral complications | Type, caused by due to, complications or manifestations, laterality | |
| E09.3532 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.621 | Diabetes mellitus due to underlying condition with foot ulcer | Type, caused by due to, complications or manifestations, laterality | |
| E09.621 | Drug or chemical induced diabetes mellitus with foot ulcer | Type, caused by due to, complications or manifestations, laterality | |
| E10.3292 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.9 | Diabetes mellitus due to underlying condition without complications | Type, caused by due to, complications or manifestations, laterality | |
| E09.44 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3549 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.69 | Diabetes mellitus due to underlying condition with other specified complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.3553 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.52 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene | Type, caused by due to, complications or manifestations, laterality | |
| E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Type, caused by due to, complications or manifestations, laterality | |
| E08.3543 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.3512 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3542 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.3513 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.59 | Other specified diabetes mellitus with other circulatory complications | Type, caused by due to, complications or manifestations, laterality | |
| E08.3391 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.37X1 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | Type, caused by due to, complications or manifestations, laterality | |
| E09.319 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema | Type, caused by due to, complications or manifestations, laterality | |
| E10.3552 | Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.8 | Diabetes mellitus due to underlying condition with unspecified complications | Type, caused by due to, complications or manifestations, laterality | |
| E10.3293 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E11.101 | Type 2 diabetes mellitus with hyperosmolarity with coma | Type, complications/manifestations, due to/caused by, temporal factors | RXHCC30, HCC17 |
| E08.44 | Diabetes mellitus due to underlying condition with diabetic amyotrophy | Type, caused by due to, complications or manifestations, laterality | |
| E08.620 | Diabetes mellitus due to underlying condition with diabetic dermatitis | Type, caused by due to, complications or manifestations, laterality | |
| E10.3591 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.620 | Drug or chemical induced diabetes mellitus with diabetic dermatitis | Type, caused by due to, complications or manifestations, laterality | |
| E09.69 | Drug or chemical induced diabetes mellitus with other specified complication | Type, caused by due to, complications or manifestations, laterality | |
| E08.3313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.3529 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.3499 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3533 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia | Type, caused by due to, complications or manifestations, laterality | |
| E09.3319 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.630 | Other specified diabetes mellitus with periodontal disease | Type, caused by due to, complications or manifestations, laterality | |
| E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.52 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene | Type, caused by due to, complications or manifestations, laterality | |
| E08.3539 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3493 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease | Type, caused by due to, complications or manifestations, laterality | |
| E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E10.3211 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy | Type, caused by due to, complications or manifestations, laterality | |
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.641 | Diabetes mellitus due to underlying condition with hypoglycemia with coma | Type, caused by due to, complications or manifestations, laterality | |
| E09.641 | Drug or chemical induced diabetes mellitus with hypoglycemia with coma | Type, caused by due to, complications or manifestations, laterality | |
| E09.3293 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E11.37X1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.3552 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3519 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E08.3299 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication | Type, caused by due to, complications or manifestations, laterality | |
| E09.49 | Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication | Type, caused by due to, complications or manifestations, laterality | |
| E13.37X9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye | Type, caused by due to, complications or manifestations, laterality | |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3513 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E09.65 | Drug or chemical induced diabetes mellitus with hyperglycemia | Type, caused by due to, complications or manifestations, laterality | |
| E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E08.3523 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality | |
| E09.3211 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | Type, caused by due to, complications or manifestations, laterality | |
| E10.3319 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy | Type, caused by due to, complications or manifestations, laterality | |
| E09.3529 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.3499 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye | Type, caused by due to, complications or manifestations, laterality | |
| E10.69 | Type 1 diabetes mellitus with other specified complication | Type, caused by due to, complications or manifestations, laterality | |
| E10.3533 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral | Type, caused by due to, complications or manifestations, laterality |