Show simple item record

dc.contributor.authorHope, SV
dc.contributor.authorWienand-Barnett, S
dc.contributor.authorShepherd, M
dc.contributor.authorKing, SM
dc.contributor.authorFox, C
dc.contributor.authorKhunti, K
dc.contributor.authorOram, RA
dc.contributor.authorKnight, BA
dc.contributor.authorHattersley, AT
dc.contributor.authorJones, AG
dc.contributor.authorShields, BM
dc.date.accessioned2021-02-05T01:37:42Z
dc.date.available2021-02-05T01:37:42Z
dc.date.issued2016-05-01
dc.identifierpii: bjgp16X684961
dc.identifier.citationHope, S. V., Wienand-Barnett, S., Shepherd, M., King, S. M., Fox, C., Khunti, K., Oram, R. A., Knight, B. A., Hattersley, A. T., Jones, A. G. & Shields, B. M. (2016). Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis. BRITISH JOURNAL OF GENERAL PRACTICE, 66 (646), pp.E315-E322. https://doi.org/10.3399/bjgp16X684961.
dc.identifier.issn0960-1643
dc.identifier.urihttp://hdl.handle.net/11343/260471
dc.description.abstractBACKGROUND: 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.
dc.languageEnglish
dc.publisherROYAL COLL GENERAL PRACTITIONERS
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titlePractical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis
dc.typeJournal Article
dc.identifier.doi10.3399/bjgp16X684961
melbourne.affiliation.departmentGeneral Practice
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleBritish Journal of General Practice
melbourne.source.volume66
melbourne.source.issue646
melbourne.source.pagesE315-E322
dc.rights.licenseCC BY
melbourne.elementsid1062666
melbourne.contributor.authorKhunti, Kamlesh
dc.identifier.eissn1478-5242
melbourne.accessrightsOpen Access


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record