Improving diabetes classification in primary care

Diabetes is a common illness that is managed mainly by doctors in general practice. There are several kinds of diabetes, and getting the right diagnosis from the start is vital to ensure people get the most effective treatment;

- People with Type 1 diabetes rapidly lose their own insulin (the hormone needed to control their blood sugar levels) so need treatment with insulin injections

- People with Type 2 diabetes may have some of their own insulin but it does not work so well, so tend to be treated by diet/lifestyle changes or tablets that aim to make the insulin they have more effective.

- People with genetic forms of diabetes (called MODY) are best treated according to the specific genetic cause: one type can be treated with a particular tablet, the other is mild and needs no treatment at all.

Getting the correct diagnosis from the beginning is not always easy, and it is estimated that for Type 1 and Type 2, about 7-15% of patients may initially be given the wrong diagnosis. For individuals with MODY, the misdiagnosis rates are even worse, with 77% of people with MODY being told they have Type 1 or Type 2 diabetes. To improve this, we have developed and tested two online calculators which can be used to help classify diabetes:

1) A Type1/Type 2 calculator which can determine how likely someone is to have Type 1 rather than Type 2 diabetes (https://www.diabetesgenes.org/t1dt2d-prediction-model/).

2) A MODY calculator which can help determine how likely someone is to have MODY (https://www.diabetesgenes.org/exeter-diabetes-app/)

We now want to embed these calculators in GP practices, to explore how they can be used to help GPs with diabetes classification, as this is where initial diagnoses are often made. To do this we will need to:

1) Work out the best way to use the information collected by GPs to make sure it is suitable for use in these calculators.

2) Add the calculators into GP computers so that they automatically link to patient records and test how this works in 20 GP practices by looking at how many patients may have been misclassified and how many need follow up for further testing/specialist referral.

3) Interview doctors, patients, and other GP practice staff and explore how they feel about the potential use of these calculators in general practice.

Combined, all this work will help us understand how these calculators could be used by GPs. It will also provide us with the information need to design a much larger study to fully assess their impact on diagnosis and management of diabetes in general practice.

Amount Awarded: £365,114