What’s the diagnosis?

The Royal College of General Practitioners (RCGP) and NHS Diabetes recently published a report aiming to improve the diagnosis, classification and coding of diabetes.

Of course, this lead to the usual scare headlines in the press, such as 100,000 ‘received wrong diabetes diagnosis’ in the Daily Telegraph.

In fact, the report provides advice and support to all clinicians involved in this often complex diagnostic challenge as well as providing free, downloadable practice audit tools to aid accurate diagnosis. You can find the full report to download by clicking either the RCGP or NHS Diabetes links above, but the preface to the report provides an excellent summary:

“It used to be thought that diabetes was a simple diagnosis – the patient was either Type 1 or Type 2. Type 1 diabetes usually occurs in younger people with sudden onset, when the pancreas no longer produces insulin and patients have to start insulin therapy straight away. In Type 2 diabetes, the pancreas either fails to make enough insulin or the body fails to respond fully to the insulin that it does produce. People with Type 2 are normally older, have often had the condition for some years and can be treated with diet and exercise, and/or medications and/or insulin therapy. However, in reality it is very often much less clear-cut in making the diagnosis of diabetes. Recent research shows that there are now many variants of diabetes and no doubt many more are yet to be discovered.

People with a health problem want to know what is wrong with them, what it means and what can be done to help them either recover or stay as well as possible whilst living with their condition. Whilst general care can always be provided, a proper diagnosis is needed before any disease or condition can be fully treated or managed effectively.

Diabetes is a complex condition that affects all parts of the body and may not always be easy to diagnose at first presentation. This challenge was previously considered by the former National Clinical Director for Diabetes, Dr Sue Roberts CBE who established a group to explore the evidence and extent of misdiagnosis and to make recommendations to assist General Practitioners in diagnosing and classifying the condition. This report shows that although the newly discovered variants of diabetes do make diagnosis more complex, Type 1 and Type 2 still represent the majority of cases. However, in a significant number of patients, mistakes are being made in identification of the type of diabetes. In particular, some Type 2 patients on insulin therapy are mistakenly labelled as having Type 1 diabetes. Mistakes like this or other errors can impact on patient information, education, treatment and their health outcomes.

This report brings together evidence of the impact an incorrect diagnosis can have on a person with diabetes, describes the current research base for evidence of misdiagnosis and misclassification, and shows the extent of that misclassification and misdiagnosis through an analysis of GPs’ records.

The report provides front line staff with a simple and easy to use classification algorithm to help make more accurate diagnoses.

The days of a simple diagnosis of either Type 1 or Type 2 are over. Of course there will be situations where the type of diabetes is unclear at first diagnosis, but treatment is still available and the diagnosis may become clearer over time. Further tests and specialist advice can help. This should be explained to the patient and the notes coded appropriately.

The contents of this report are a significant step forward in ensuring that when people are diagnosed with diabetes, the diagnosis is right and appropriate treatment is recommended. It will be of interest to anyone involved in providing diabetes care, people with diabetes and researchers.

Our thanks go to all the people who have contributed to this important piece of work.”

You can find out more about our Diabetes Management training course by clicking this link to our website.

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