A report commissioned by the Royal College of General Practitioners (RCGP) and NHS Diabetes has recommended new guidance on how diabetes is diagnosed in England, with around five per cent of current diagnoses found to have mistakes.
‘Improving the diagnosis, classification and coding of diabetes’ examined existing levels of three error types found among people diagnosed with diabetes, and described practical classification guidelines to help GPs diagnose variants of the condition in patients.
The three error types are misdiagnosis, when someone is incorrectly diagnosed as having diabetes when they do not have it; misclassification, when someone is diagnosed as having a different type of diabetes to the one they actually have; and miscoding, when the information encoded by doctors into a computer database is incorrect.
Further analysis was done involving data from two previous studies, with ‘pragmatic’ guidelines developed in response to establish whether a person has a variant of diabetes – type 1, type 2, genetic, other and unknown/unclassified – or had non-diabetic hyperglycaemia.
From the guidelines, an audit tool was developed to help uncover any diagnostic errors in a practice’s patient records, and to classify a person’s diabetes.
A pilot of the audit tools covering 45,000 patients over five practices found that, of around 1,600 people with diabetes, 2.2 per cent had been misdiagnosed, 2.1 per cent had been misclassified and 0.9 per cent had been miscoded.
There are around two million people diagnosed with diabetes in England. If the results of the audit were reflected on a national scale, this would mean around 100,000 people had mistakes in their diabetes diagnosis, with around 50,000 of that population incorrectly diagnosed as having the condition.
Dr Rowan Hillson, national clinical director for diabetes, acknowledged the errors, but also commented on her hopes for the audit tools and revised guidelines: “In a few complex cases people may have been misdiagnosed with diabetes or the type of diabetes misclassified, but this shouldn’t significantly affect their treatment. However, with 2 million people diagnosed with diabetes in England and the numbers predicted to go much higher, the classification algorithm and audit tools provided today make a valuable contribution to help GPs with diagnosis, classification and coding of diabetes.”
Anna Morton, director of NHS Diabetes, discussed the organisation’s goal to see the recommendations spread nationwide: “The key aim of NHS Diabetes is to work with frontline staff to improve diabetes care and we will be using all our efforts to see its recommendations translated into clinical practice across England.”
The report is available from NHS Diabetes.
The audit tools are available from Clinical Informatics Research Group.