A new report, launched by the Royal College of General Practitioners and NHS Diabetes, aims to improve the diagnosis, classification and coding of diabetes. It 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.

It outlines:

- The results of a systematic review examining existing evidence on misdiagnosis, misclassification and miscoding

- The results of an analysis of two primary care databases of nearly one million patients establishing the extent of misdiagnosis, misclassification and miscoding

- Pragmatic Guidelines for diagnosis and classification

- Audit tools to improve diagnosis, classification and coding in clinical practice and the results of a pilot using them

A pilot of the audit tools across five practices with 1600 people on diabetes registers found 2.2% of people diagnosed with diabetes did not have it, 2.1% of people were classified with the wrong type of diabetes and 0.9% of people had their type of diabetes coded as indeterminable.

Dr Clare Gerada, Chair of the RCGP and a practising GP in London, said: "Diabetes is a growing concern for GPs and their teams and it is crucial that patients receive the correct diagnosis so that they can start to receive the appropriate treatment and care.

"The report found that the overwhelming majority of people are correctly diagnosed with what is increasingly recognised as a very complex condition. However in a few cases people have been misdiagnosed, misclassified or miscoded with diabetes. The new guidelines and audit tools will be of great benefit to doctors and patients and we will be working very closely with our members and other primary care colleagues to introduce them into widespread clinical practice."

Dr Rowan Hillson, National Clinical Director for Diabetes, said: "It is reassuring that the vast majority of people with diabetes are correctly diagnosed. 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, said: "I am delighted that we worked with the RCGP and colleagues from across the diabetes community to produce this report. 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."

Avril Surridge, who has diabetes, said: "From talking to friends and colleagues I know how hard diagnosis hits people. To be told later that you do not have diabetes can be wonderful news but also distressing to realise they have lived under an unnecessary shadow sometimes for some time. Similarly, to be diagnosed with one type of diabetes and then later to have that changed to diagnosis of another type is both alarming and confusing and raises queries about the treatment they have had. I really hope that the recommendations in this report are taken up very quickly so that the accuracy of a diagnosis of diabetes improves."

Professor Kamlesh Khunti of the University of Leicester, Chair of the Working Group, said: "Producing this report has been a truly collaborative effort involving a number of academic institutions, people with diabetes, professional bodies and other stakeholders from the diabetes community. I am confident the publication of this report is a significant step forward in understanding why people with diabetes are misdiagnosed, misclassified and miscoded and in providing practical advice on how to improve this in the future."

The report Coding, Classification and Diagnosis of Diabetes: A review of the coding, classification and diagnosis of diabetes in primary care in England with recommendations for improvement can be seen here.

Notes

1. The report uses the following definitions:

- Misdiagnosis is when someone is diagnosed with any form of diabetes when they do not have it

- Misclassification is when someone is incorrectly classified as having a type of diabetes that they do not have

- Miscoding is when the wrong computer read code is used, meaning that it is not possible to determine the type of diabetes precisely

2. There are predicted to be three million people with diabetes in England with two million of them diagnosed. Prevalence models from Diabetes Health Intelligence predict this to rise to 3.8 million by 2020 and 4.6 million by 2030.

See here.

3. Diabetes is associated with a range of complications including heart attack, stroke and kidney failure. It is the largest single cause of blindness in working age people as well as being responsible for 70 amputations of lower limbs a week.

Source:
Royal College of General Practitioners