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CHAPTER 5

A CASE OF DIABETES ONTOLOGY

5.1 About Diabetes

The functioning of OntoSri tool is tested with a case of Diabetes ontology.

This chapter presents the basics of diabetes, ontology development and use case description

of OntoSri with a case of diabetes ontology

Glucose is essential for providing energy for normal body functions. In

diabetes the blood glucose levels are increased due to relative or absolute deficiency of

insulin. Insulin is a hormone. A Hormone is a chemical secreted by one of the glands in our

body. This gland is situated in abdomen and is known as pancreas. Insulin acts as a

gatekeeper that allows entry of glucose into the cell. If the amount of insulin is abnormal or

the function of insulin is at fault excess of glucose accumulates in the body with harmful

effects on the cells of various organs. Diabetes is a metabolic disorder in which body is

unable to handle glucose for its energy requirements. Insulin is essential for entry of glucose

in to the cell that is why

1) Cells cannot adequately utilize glucose, so

2) Body tries to produce more glucose (gluconeogenisis).

This is how blood glucose keeps on rising even if there is no food intake. There

are two major types of diabetes. The first type i.e. insulin dependent diabetes. It can be

treated only with insulin as the main drug. This is common in younger age group of patients.

The second type is non-insulin dependent diabetes (Type II). This is more common in India.

This usually affects people above 40 years of age. This group can be managed with diet,

exercises and oral medications. Some patients in this group may require insulin sometime

later in life. The comparison of two types of diabetes is shown in following table 5.1.

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Table 5.1: Comparison of Two Types of Diabetes

FEATURE TYPE I (IDDM) TYPE II (NIDDM)

Age of Onset Younger age group above 30-35 years

Insulin level in blood Negligible Decreased or High

Bodyweight Underweight or Normal Overweight or Normal

Usual Treatment Insulin Oral and Insulin

Inheritance Less Significant More Significant

Uncontrolled diabetes can lead to deleterious effects on every part of the body if not

looked after well at the right time. Even if one may not, in actual sense suffer the

consequences of the disease today, it needs to be adequately treated. Complacency and

neglect is always dangerous. The disease has to be well controlled as it is critical in leading

normal life. Poorly controlled diabetes can be a major aggravating factor for later diabetes

complications. Following table 5.2 shows some of these complication risks. One should know

how important it is to control diabetes and not to scare one about this disease.

Table 5.2 Complication Risks

Complication Frequency, in comparison to non-diabetics

Retinopathy leading to blindness 25 times higher

Kidney disease 15-20 times higher

Foot problems 20-30 times higher

Paralysis 2 times higher

Heart disease 2-4 times higher

One should understand how this disease starts making its impression on your

life. Usually, disease creeps in silently. One comes to know of it generally during routine

blood sugar test for getting licenses, insurance etc. Sometimes it is detected only during

treatment of other concomitant illness or before surgery.

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Following are the common manifestations of diabetes.

Report as a surprise

Increased appetite and thirst

Significant weight loss

Infections in folds

Increased urination

Exhaustion

Testing Themselves for Diabetes:

1. Everybody with above mentioned symptoms.

2. Close relatives of Diabetes Patients.

For Type 1 diabetes hereditary factor is less prominent.

If a father is diabetic then the risk to the child is 5-10%.

If a mother is diabetic then the risk is 5%.

Type 2 or NIDDM has significant genetic predisposition.

If one parent has diabetes the risk is 40%.

If both parents are diabetic the risk is 90%.

3. Pregnant women Diabetes is not uncommon due to various hormonal and

Metabolic changes Uring pregnancy.

4. Those having high blood pressure, obesity, heart disease and paralysis etc.

5. A lady who delivered a baby weighing more than 4.5 kg

6. All above 45 years of age should check their sugar level once in a year.

Diabetes Detection:

Estimation and interpretation of blood glucose is the only test for diagnosis

of diabetes. World Health Organization (WHO) has laid down guidelines for diagnosis.

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Criteria for Diagnosis of Diabetes:

Fasting Venous plasma glucose > 140 mg/100ml and Two hours after 75 gm ingestion

of glucose > 200 mg /100ml Recently, American Diabetes Association has accepted the

fasting plasma glucose values as >126mg/100ml for diagnosis of diabetes.

Blood Test Preparation:

How one should prepare for the blood test is also very important. The person

should have normal diet 3-4 days prior to the test. One shouldnot try to reduce sugar intake

purposely just to show less blood sugar values. By this, one is not only fooling the doctor but

oneself also. Actually one is delaying the diagnosis which may prove very costly later. One

should to diagnose the disease so as to take correct measures to control it at the earliest time.

One should remember that by checking sugar levels doctors are not making one a patient but

trying to avoid serious complications related to high sugars.

A) At the time of blood test the person should be fasting overnight. The person can have

water.

B) The next morning fasting blood glucose sample is collected.

C) Two hours after 75g of glucose load or lunch second blood glucose sample is collected.

Another way is, to give post lunch plasma sample on one day and to give fasting

glucose sample next morning. A known diabetic patient is supposed to follow the normal

daily routine on the day of blood test also. That means the timings of breakfast, medicines

and the lunch should be followed on this day as usual. The doctor can do any modification in

the drug and the doses if the patient follows a regular schedule on the blood test day. Diabetes

management for each person is different. Do not compare one’s doses and drugs with other

patients. Management of Diabetes is not only sugar control but much more beyond that.

Controlling Diabetes:

Basic idea of control is that the person should get relief from the symptoms also;

blood biochemistry must be in an acceptable range (Table 5.3) so as to avoid acute and long-

term complications due to UNCONTROLLED DISEASE. It is important to know the fact

that though the blood biochemistry prescribes normal range of values, they may be little more

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or less without causing any alarm signals. Hence one should be aware of the concept of

Acceptable Controls.

Table 5.3 Blood Biochemistry

Parameter Good control Acceptable control

Fasting plasma glucose 80-120 mg/dl £ 140 mg/dl

Post prandial plasma glucose 140-160 mg/dl £ 180 mg/dl

Glycated haemoglobin <7 % 7 to 8 %

Total cholesterol 180 mg/dl 200 mg/dl

HDL cholesterol 40 mg/dl 35 mg/dl

Triglycerides 150 mg/dl < 180 mg/dl

All these values have to be correlated with other factors like associated disease,

patient’s age etc. The management will depend upon overall health of the patient and

certainly not on blood reports! Regular medical examination includes

· Monthly weight record

· Blood pressure check up

· Blood glucose testing

· Complete lipid profile

· Urine and blood tests for assessing kidney functions

· Tests for evaluation of heart disease

· Examination of eyes

· Evaluation of diabetic foot changes

· Any sexual problems

Other specialized tests can be suggested depending upon results of tests mentioned

above and the clinical examination by the specialist.

Diabetes Care Schedule:

Every 3-6 Months:

Regular visits to your doctor, it includes

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· Test for plasma glucose levels

· Glycated hemoglobin test (such as HbA1c)

· Examination of injection site.

· Feet: examined without shoes and socks

Every Year:

· Cholesterol: fasting profile including HDL & LDL cholesterol and triglycerides.

· Kidneys: microalbumin measured

· Eyes: examined through dilated pupils

Every 2-3 Years:

· HDL/cholesterol: if the last reading was normal

· Number of visits to the doctor depends on the control of blood sugar.

5.1.1 About Diabetes Database:

The classification of Diabetes (Super Class) includes 15 subclasses

namely, Doctor Details , Patient Details , Medical Category, Diet, Specialization,

Complication Of Diabetes, Medical Condition, Diabetes Surveillance Record I, Diabetes

Surveillance Record II, Diabetes Hospital Details, Diet Timing, Diet Type, Insulin Does If

Appropriate, Blood Glucose, and Affecting Disease and also includes 67 Objects with 257

Instances.

Class : Diabetes

Sub class: Doctor Details

Object : GP Name : Dr.K.Mohan

Address : Vaikolkara Street, Thanjavur

Practice nurse : Kavitha

Surgery Address : Nursing home

Phone No : 9003686787

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Sub class: Patient Details

Object : PNo : 101

Pname : Uma Devi

Year of Identification : 2009

Address : Rajiv Street

Phone No : 9021456841

Suggested Drugs : Danonil,Glimel

Sub class : Medical Category

Object : Type : I

Year Of Identification Of Type I : 2009

Year Diagnosed : 2009

Symptoms at diagnosis : Burning foot

Symptoms of Type I : Burning Finger

Weight : 85 kg

Height : 155 cm

Year tablet started : 2009

Year insulin started : 2011

Family history : Yes

Sub class: Diet

Object : Tablets : Daonil, Glimel

Drug Manufacturer : Ranbaxy

Physical activity : Exercise

Insulin and injecting : 2010 – p.insulin

Hypoglycaemia : 2010 Jan

Hyperglycaemia : 2009 Nov

Blood testing : Every month

Foot care : Once in 3 month

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Eye checks : Once in 3 month

Smoking : No

Alcohol : No

Sub class: Specialization

Object : Pharmacist : M.Deepa

Dietitian : K.Kumaran

Podiatrist : P.Sathish

Phone No : 04362-222054

Sub class : Complication of diabetes

Object : Diabetic eye disease : Refractive error

Diabetic kidney disease : Alburnia +

Diabetic foot disease : Tingling sensation

Sub class: Medical Condition

Object : High blood pressure : 140/100

High cholesterol : 220

Angina : Ischaemia

Transient ischaemic attack : Yes

Stroke : No

Peripheral vascular disease : No

Sub class: Diabetes Surveillance Record I

Object : Fasting blood glucose : 8.9

HbA1c% : 10.8

Smoking : Nil

Blood pressure : 140/100

Cholesterol : 4.5

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Sub class: Diabetes Surveillance Record II

Object : Weight : 85 kg

Body Mass : 20.5

Eye Grade : 0.4

Foot Grade : High Risk

Sub class: Diabetes Hospital Details

Object : Hospital Name : P.K.R.Hospital

Hospital Address : Thanjavur

Phone No : 04362-222265

Sub class: Diet Timing

Object : Time Difference : After ½ Hour

Sub class: Diet Type

Object : Type Name : Type I

Sub class: Insulin Does If Appropriate

Object : Morning : 07.30 A.M.

Afternoon : 12.30 A.M.

Evening : 07.30 A.M.

Sub class: Blood Glucose

Object : Breakfast : 08.00 A.M.

Lunch : 01.00 P.M.

Dinner : 08.00 A.M.

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Sub class: Affecting Disease

Object : Heart Attack : No

Transient ischaemic attack : Yes

5.2 Diabetes Ontology Design

5.2.1 Individuals :

Individuals, represent objects in the domain. This means that two different names

could actually refer to the same individual. For example, “101”, “102” and

“DR.K.MOHAN”,”KAVITHA HOSPITAL” might all refer to the same individual. In

OntoSri, it must be explicitly stated that individuals are the same as each other, or different to

each other — otherwise they might be the same as each other, or they might be different to

each other. Figure 5.1 shows a representation of some individuals as diamonds in some

domain.

KAVITHA HOSPITAL

101 102

DR.K.MOHAN

Figure 5.1 Representation of Individuals

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5.2.2 Properties:

Properties are binary relations on individuals - i.e. properties link two individuals

together. For example, the property “IS PATIENT” might link the individual “101” to the

individual “kavitha hospital”. Properties can be limited to having a single value i.e. to being

functional. They can also be either transitive or symmetric. Figure 5.2 shows a representation

of some properties linking some individuals together.

IS PATIENT

KAVITHA HOSPITAL

101

HAS SIBLING 102

Figure 5.2 Representation of Properties

5.2.3 Classes:

OntoSri classes are interpreted as sets that contain individuals (Figure 5.3). They are

described using formal (mathematical) descriptions that state precisely the requirements for

membership of the class. For example, the class contains all the individuals that are

represented as circles or ovals, rather like sets in Venn diagrams.

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IS PATIENT

DOCTOR

IS PATIENT

PATIENT

HOSIPTAL

Figure 5.3 Representation of Classes (Containing Individuals)

5.2.4 Diabetes Properties:

OntoSri Properties represent relationships (Figure 5.4). There are two main types of

properties, Object properties and Data type properties. Object properties are relationships

between two individuals Object properties link an individual to an individual. Annotation

properties can be used to add information (metadata — data about data) to classes,

individuals and object/data type properties.

102 101

KAVITHA KUMARAN

DR.MOHAN DR.VINO DR.BALA

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PATIENT

101 102

HAS AGE

101 55

Figure 5.4 The Different Types Of Diabetes Properties

5.2.5 Symmetric Properties: If a property P is symmetric, and the property relates individual a to individual b then

individual b is also related to individual a via property P. Figure 5.5 shows an example of a

symmetric property. If the individual 101 is related to the individual 102 via the

HASPATIENT property, then one can infer that 102 must also be related to 101 via the

HASPATIENT property. In other words, if 101 have a sibling that is 102, then 102 must have

a sibling that is 101.

HAS SIBLING

101 102

HAS SIBLING

Figure 5.5 An Example of Symmetric Properties

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5.2.6 Antisymmetric Properties: If a property P is antisymmetric, and the property relates individual a to individual b then

individual b cannot be related to individual a via property P. Figure 5.6 shows an example of

a antisymmetric property. If the individual 101 is related to the individual Dr.Mohan via the

ISPATIENTOF property, then it can be inferred that Dr.Mohan is not related to 101 via the

ISPATIENTOF property. It is, however, reasonable to state that Dr.Mohan could be related

to another individual Kavitha Nursing Home via the is DoctorOf property. In other words, if

101 is a PatientOf Dr.Mohan, then Dr.Mohan cannot be a PatientOf 101, but Dr.Mohan can

be a DoctorOf Kavitha Nursing Home.

IS PATIENT OF

101 DR.MOHAN

IS PATIENT OF

Figure 5.6: An Example of Antisymmetric Properties

5.2.7 Reflexive properties:

A property P is said to be reflexive when the property must relate individual a to itself. In

Figure 5.7 one can see an example of this: using the property knows, an individual Dr.Mohan

must have a relationship to itself using the property knows. In other words, Dr.Mohan must

know herself. However, in addition, it is possible for Dr.Mohan to know other people;

therefore the individual Dr.Mohan can have a relationship with 101 along the property

knows.

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KNOWS

Is Doctor Of

DR.MOHAN 101

Figure 5.7An Example of Reflexive Properties

5.2.8 Irreflexive properties:

If a property P is irreflexive, it can be described as a property that relates an individual a

to individual b, where individual a and individual b are not the same. An example of this

would be the property DOCTOROF: an individual Dr.Mohan can be related to individual 101

along the property DOCTOROF, but Dr.Mohan cannot be DOCTOROF herself Figure 5.8.

IS PATIENT OF

DR.MOHAN 101

IS PATIENT OF

Figure 5.8 An Example of Irreflexive Properties

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5.2.9 Transitive Properties:

If a property P is transitive, and the property relates individual a to individual b and

also individual b to individual c, then one can infer that individual a is related to individual c

via property P. Figure 5.9 shows an example of a transitive property. If the individual 101 is

related to the individual Type, and Type IS TYPE II PATIENT OF Kavitha Hospital, then

one can infer that 101 IS TYPE II PATIENT OF Kavitha Hospital.

IS TYPE II PATIENT OF

I KAVITHA HOSPITAL

IS TYPE II PATIENT OF

Type

101

IS TYPE II PATIENT OF

Figure 5.9 An Example of Transitive Properties

Table 5.4 shows five Object Properties namely, Transitive Property, Symmetric Property,

Antisymmetric Property, Reflexive Property and Irreflexive Property. The respective

relationships are, IS TYPE II PATIENT OF, HAS SIBLING, IS PATIENT OF, IS NOT

PATIENT OF, IS DOCTOR OF and KNOWS

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Table 5.4 Concept Level Relationship

Object Properties Relationship Description

Transitive Property

IS TYPE II PATIENT OF X <IS_TYPE II_PATIENT_OF> Y. E.g. “101” < IS_TYPE II_PATIENT_OF> “TYPE”.

IS TYPE II PATIENT OF

Y<IS_TYPE II_PATIENT_OF> Z. E.g. “TYPE” < IS_TYPE II_PATIENT _OF> “KAVITHA HOSPITAL”.

IS TYPE II PATIENT OF

X <IS_TYPE II_PATIENT_OF> Z. E.g. “101” < IS_TYPE II_PATIENT _OF> “KAVITHA HOSPITAL”.

Symmetric Property HAS SIBLING X <HAS_SIBLING> Y. E.g. “101” <HAS_SIBLING> “102”

Antisymmetric Property

IS PATIENT OF X <IS_PATIENT_OF> Y. E.g. “101” <IS_PATIENT_OF> “DR.MOHAN”.

IS NOT PATIENT OF Y < IS_NOT_ PATIENT_OF > X. E.g.”DR.MOHAN” < IS_NOT_PATIENT_OF > “101”.

Reflexive Property

IS DOCTOR OF X <IS_DOCTOR_OF> Y. E.g.”DR.MOHAN” <IS_DOCTOR_OF> “101”.

KNOWS X <KNOWS> X. E.g. “DR.MOHAN” <KNOWS> “DR.MOHAN”.

Irreflexive Property

IS PATIENT OF X <IS_ PATIENT_OF> Y. E.g.”DR.MOHAN” <IS_ PATIENT_OF> “101”.

IS NOT PATIENT OF

X <IS_NOT_ PATIENT_OF> Y. E.g.”DR.MOHAN” <IS_NOT_ PATIENT _OF> “DR.MOHAN”.

5.3 Description of Use Cases of OntoSri for the Case Study

OntoSri provides developers, researchers, educators, and learners the ability to

retrieve information about Diabetes systems meeting specific criteria, to get detailed

information about a particular system of interest, to add a system to the database, and to

provide feedback about OntoSri or any Diabetes system currently classified in OntoSri.

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Figure 5.10 is a screenshot of the homepage that displays a visualization of the Diabetes

ontology and a toolbar that allows access to the various OntoSri operations.

Figure 5.10 OntoSri Homepage.

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Figure 5.11 OntoSri Create Class.

Name: Create Class Description: Create a new class for Ontology.

Actors: Ontologiest

Flow: 1. Ontologiest should click the tab ‘Create Class’ 2. Enter class name “Patient Detial” in text tab. 3. Click ‘Create Class’ button. 4. If the class name already exists, then enter a new name. 5. Click button ‘Create Class’ to create new class. 6. Repeat step 2 for more classes. 7. Press right to remove one or more classes. Post conditions: The new class will be created as “Patient Details”.

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Figure 5.12 OntoSri Adding Objects.

Name: Create Object properties Description: Create the Object properties of the classes.

Actors: Ontologiest

Flow:

1. Ontologiest should click the tab ‘Adding Object’ 2. Choose class “Complication of Diabetes” from list box tab. 3. Give object name “Diabetic eye diseases” ,” Kidney diseases”, “Foot diseases” and data type ”General”. 4. Click ‘Add’ button. 5. If object name already exists, then enter a new object name. else create an object on that name. 6. Repeat step 2 for more objects. 7. Press right to remove one or more objects. Post conditions: The new object properties will be created “Complication of Diabetes”.

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Figure 5.13 OntoSri Relationship.

Name: Create Relationships Description: Create the relationships between classes.

Actors: Ontologiest Flow: 1. Choose class and object of the class1 tab as “Patient Details” 2. Next, choose class and object of the class2 tab as “Doctor Details” 3. Click button ‘Create Relation’. 4. Repeat step1 to create more relations. Post conditions: Relationships created between the classes “Patient Details” and “Doctor Details”.

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Figure 5.14 OntoSri Available Classes.

Name: Available classes Description: Shows the classes which are available in the particular ontology.

Actors: Ontologiest Flow: 1. Choose Super class (i.e. Diab) 2. Display subclasses of the chosen super class. Post conditions: Will show the subclasses as “Patient Details” of the chosen super class.

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Figure 5.15 OntoSri Create Instance.

Name: Create Instances Description: Create the Instances of objects for the classes.

Actors: Ontologiest

Flow: 1. Ontologiest should click the tab ‘Create New Instance’ as “Patient Details” 2. Choose the class from list box tab. 3. Give the instance values of the text box tab, and click ‘Complete’ button as “PNo, PName, Address, Year of Registration, Phone No, and Prescribed Drugs”. 4. Repeat step 1 for more objects. 5. Press right to remove one or more objects. Post conditions: The new instance values of the objects will be created for classes as Patient Details.

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Figure 5.16 OntoSri OntoGraph.

Name: OntoGraph Description: Show the particular ontology in graphical view.

Actors: Ontologiest

Flow: 1. Click the tab ‘OntoGraph’ 2. Display the title ‘ OntoSri Classes’. 3. Click OntoSri Classes to visualize Super classes as “OntoSri Class”. 4. Select any one of the super classes. Shows the subclasses of the Selected super class. 5. Go to initial stage, just click again. Post conditions: Visualizes ontology in graphical view in the form of tree as given Sixteen Nodes in figures.

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Figure 5.17 OntoSri OntoGraph- Find

Name: Find

Description: To find the particular values of instance

Actors: Ontologiest

Flow:

1. Click the tab ‘Find’

2. Choose the class and object property as “Patient Details, PNo and 101”.

3. Give the value of the text box. Then Click the button ‘Search’,

3.1. If the value is true, then shows the data structure table of the class.

3.2 Otherwise the message shows no record(s) found

4. Click button ‘Show All’ to view all the values of the particular class,

Post conditions: Search results of some or all values of the class of any one of the

ontologies.

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Figure 5.18 OntoSri OntoGraph- Reasoner

Name: Reasoner Description: To find values of all ontology

Actors: Ontologiest

Flow: 1. Click the tab ‘Reasoner’ 2. Display the text box tab. Enter the string or part of the instance value. 3. Then Click button ‘Search’, 3.1. If the value is true, then shows the data(s) and respective classes of all ontology. 3.2 Otherwise the message shows no record(s) found Post conditions: Search results of some or all values of the class of any one of the ontologies.