Tags

Type your tag names separated by a space and hit enter

Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis.
Br J Gen Pract 2016; 66(646):e315-22BJ

Abstract

BACKGROUND

Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation.

AIM

To assess diagnostic accuracy of the UK guidelines against 'gold standard' definitions of type 1 and type 2 diabetes based on measured C-peptide levels.

DESIGN AND SETTING

In total, 601 adults with insulin-treated diabetes and diabetes duration ≥5 years were recruited in Devon, Northamptonshire, and Leicestershire.

METHOD

Baseline information and home urine sample were collected. Urinary C-peptide creatinine ratio (UCPCR) measures endogenous insulin production. Gold standard type 1 diabetes was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR<0.2 nmol/mmol ≥5 years post-diagnosis); all others classed as having type 2 diabetes. Diagnostic performance of the clinical criteria was assessed and other criteria explored using receiver operating characteristic (ROC) curves.

RESULTS

UK guidelines correctly classified 86% of participants. Most misclassifications occurred in patients classed as having type 1 diabetes who had significant endogenous insulin levels (57 out of 601; 9%); most in those diagnosed ≥35 years and treated with insulin from diagnosis, where 37 out of 66 (56%) were misclassified. Time to insulin and age at diagnosis performed best in predicting long-term endogenous insulin production (ROC AUC = 0.904 and 0.871); BMI was a less strong predictor of diabetes type (AUC = 0.824).

CONCLUSION

Current UK guidelines provide a pragmatic clinical approach to classification reflecting long-term endogenous insulin production; caution is needed in older patients commencing insulin from diagnosis, where misclassification rates are increased.

Authors+Show Affiliations

NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;Research and Development Unit, Northampton General Hospital, Northampton.Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester and the Leicester Diabetes Centre (Air Wing), Leicester General Hospital, Leicester.NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;NIHR clinician scientist and StR in endocrine and diabetes, and general internal medicine;University of Exeter Medical School and Royal Devon and Exeter NHS Foundation Trust, Exeter NIHR Clinical Research Facility, Barrack Road, Exeter.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27080317

Citation

Hope, Suzy V., et al. "Practical Classification Guidelines for Diabetes in Patients Treated With Insulin: a Cross-sectional Study of the Accuracy of Diabetes Diagnosis." The British Journal of General Practice : the Journal of the Royal College of General Practitioners, vol. 66, no. 646, 2016, pp. e315-22.
Hope SV, Wienand-Barnett S, Shepherd M, et al. Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis. Br J Gen Pract. 2016;66(646):e315-22.
Hope, S. V., Wienand-Barnett, S., Shepherd, M., King, S. M., Fox, C., Khunti, K., ... Shields, B. M. (2016). Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis. The British Journal of General Practice : the Journal of the Royal College of General Practitioners, 66(646), pp. e315-22. doi:10.3399/bjgp16X684961.
Hope SV, et al. Practical Classification Guidelines for Diabetes in Patients Treated With Insulin: a Cross-sectional Study of the Accuracy of Diabetes Diagnosis. Br J Gen Pract. 2016;66(646):e315-22. PubMed PMID: 27080317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis. AU - Hope,Suzy V, AU - Wienand-Barnett,Sophie, AU - Shepherd,Maggie, AU - King,Sophie M, AU - Fox,Charles, AU - Khunti,Kamlesh, AU - Oram,Richard A, AU - Knight,Bea A, AU - Hattersley,Andrew T, AU - Jones,Angus G, AU - Shields,Beverley M, Y1 - 2016/04/14/ PY - 2015/07/01/received PY - 2015/12/23/accepted PY - 2016/4/16/entrez PY - 2016/4/16/pubmed PY - 2017/5/20/medline KW - C-peptide KW - diabetes mellitus KW - general practice KW - insulin-treated diabetes KW - type 1/type 2 classification KW - type 1/type 2 diagnosis SP - e315 EP - 22 JF - The British journal of general practice : the journal of the Royal College of General Practitioners JO - Br J Gen Pract VL - 66 IS - 646 N2 - BACKGROUND: Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation. AIM: To assess diagnostic accuracy of the UK guidelines against 'gold standard' definitions of type 1 and type 2 diabetes based on measured C-peptide levels. DESIGN AND SETTING: In total, 601 adults with insulin-treated diabetes and diabetes duration ≥5 years were recruited in Devon, Northamptonshire, and Leicestershire. METHOD: Baseline information and home urine sample were collected. Urinary C-peptide creatinine ratio (UCPCR) measures endogenous insulin production. Gold standard type 1 diabetes was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR<0.2 nmol/mmol ≥5 years post-diagnosis); all others classed as having type 2 diabetes. Diagnostic performance of the clinical criteria was assessed and other criteria explored using receiver operating characteristic (ROC) curves. RESULTS: UK guidelines correctly classified 86% of participants. Most misclassifications occurred in patients classed as having type 1 diabetes who had significant endogenous insulin levels (57 out of 601; 9%); most in those diagnosed ≥35 years and treated with insulin from diagnosis, where 37 out of 66 (56%) were misclassified. Time to insulin and age at diagnosis performed best in predicting long-term endogenous insulin production (ROC AUC = 0.904 and 0.871); BMI was a less strong predictor of diabetes type (AUC = 0.824). CONCLUSION: Current UK guidelines provide a pragmatic clinical approach to classification reflecting long-term endogenous insulin production; caution is needed in older patients commencing insulin from diagnosis, where misclassification rates are increased. SN - 1478-5242 UR - https://www.unboundmedicine.com/medline/citation/27080317/Practical_Classification_Guidelines_for_Diabetes_in_patients_treated_with_insulin:_a_cross_sectional_study_of_the_accuracy_of_diabetes_diagnosis_ L2 - http://bjgp.org/cgi/pmidlookup?view=long&amp;pmid=27080317 DB - PRIME DP - Unbound Medicine ER -