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At the heart of general practice since 1960

One in 20 diabetes diagnoses a 'serious error'

By Lilian Anekwe

GPs have been told to review all of their patients with diabetes to identify the one in 20 patients that research suggests may have been misdiagnosed or incorrectly classified with the disease.

The results of an extensive analysis of practice registers, conducted by the RCGP, found 5% of the records of patients with diabetes had ‘important errors', including misdiagnosis, misclassification or miscoding.

The research, by GP experts in diabetes and primary care informatics, audited data for around a million patients in two primary care databases identified that overall, 85-90% of data on diabetes is fit for purpose, ‘but that there is room for improvement'.

An audit of five practices in southeast England with a combined list size of approximately 45,000 found that 2.2% of people diagnosed with diabetes in primary care did not have the condition, 2.1% of patients were classified with the wrong type of diabetes and 0.9% had their type of diabetes coded as ‘indeterminable'.

This means in an average practice, for every 500 people identified with diabetes on a practice register, between 65 and 70 will need to be looked at ‘for some sort of error'.

Of the 65-70 people, 7-16 cases will be where the wrong sort of diabetes has been diagnosed, the majority of which will be incorrectly diagnosed type 1 diabetes when the person really has type 2 diabetes.

About 21 people will be incorrectly diagnosed with diabetes when they do not have it, and there will be 24-37 miscodings.

‘Overall the effect of the audit was to change the diagnosis of around a quarter of the people identified', the report concludes.

The report also flagged up issues that may be clamped down on in future versions of the QOF – with the Department of Health keen to see changes to address the misdiagnosis, and any mispayments to GPs.

‘There is currently no incentive to code secondary or gestational diabetes correctly; indeed correct coding may undermine income. Discussions are needed to explore whether the algorithm in this documents should become part of the QOF recognised denominator population for then diabetes indicator' it concluded.

Lead researcher Professor Kamlesh Khunti, professor of diabetes and vascular medicine at the University of Leicester and clinical advisor for the diabetes NICE-led QOF panel, added: ‘The QOF only has type 1 and type 2 diabetes and that fundamentally has to change to allow us to cater for other kinds of diabetic patients.'

Professor Simon de Lusignan, professor of primary care and clinical informatics at the University of Surrey, developed a new online tool to help practices audit their patients with diabetes.

He said: ‘I think what GPs should be doing is systematically checking medical records in time for when people attend for their six-monthly or annual review, or before every diabetes clinic.

‘For the majority of people misdiagnosed or misclassified it won't significantly impact on their care. But reclassification will in the long term improve it.'

Launching the audit, RCGP chair Dr Clare Gerada 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 tool can be accessed here and is downloadable free of charge.

Patients with type 2 diabetes on insulin may be misclassified

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