December 4, 2012

Did You Receive The Correct Diabetes Diagnosis?

If you agree that newly diagnosed patients do not always receive advice on managing their diabetes, including testing information read my blogs here and here. Then you need to wonder if patients are receiving the correct diagnosis. The disturbing factor is the misdiagnosed patients are not reported to any database. Often it is the patient, the doctor, and maybe a few family members that ever know about the misdiagnosis. Yes, the insurance carrier knows, but they generally will not release any information. This should be a concern for any newly diagnosed patient. The lack of a diabetes database and a database for improperly diagnosed diabetes patients allows doctors to continue without problems or even a review by state practice boards.

This is disturbing because this includes all forms of diabetes, type 1, type 2, LADA, and MODY. No one can say what the actual numbers are and that is the shame for people with diabetes. How can we put trust in the medical community that wants to keep this buried? Until states and the federal government establish these databases and make reporting mandatory, this will continue to be a problem. Doctors will have no incentive to be more careful in their initial diagnosis. These databases will also need to available for review by diabetes patients to report incidents of misdiagnosis for confirmation. These databases could also be valuable for other doctors and diabetes patients to determine the number of misdiagnosed patients by doctor to discover reasons to question a diabetes diagnosis by the doctors with large numbers of these patients.

As I explained here, diabetes diagnosis is not as cut and dried, as many would think. I talked about many of the tests in this blog and it never hurts to review them. “Can the A1c be used initially to screen for diabetes? Some doctors do use it for screening. Other doctors prefer a fasting blood glucose (FBG), the oral glucose tolerance test (OGTT), and the A1c before they will diagnose diabetes. Another test in the diagnosis arsenal is the fasting plasma glucose (FPG) test. Still other doctors will use other tests to make sure it is type 2 and not type 1 or LADA. The C-peptide is also used to determine insulin resistance or the amount of insulin your body is producing. Levels of autoantibodies to insulin and the beta cells can be of some value but even these do not lead to an airtight diagnosis. This is because not all people with type 1 have these antibodies. Therefore, the diagnosis is still largely a clinical one.”

I will also refer people to this website lab tests online dot org for a list of tests used for diabetes. This has a discussion of - tests for screening, tests for diagnosis, and tests for monitoring. I would urge people to know the different tests and what their doctor used for their diagnosis. Not covered is the tests for maturity-onset diabetes of the young (MODY) as this is a very specific and sometimes expensive test. Information on MODY can be found here and the six types of MODY are listed in a chart near the bottom of the page.

Most cases of misdiagnosis are people with LADA being initially diagnosed as type 2 diabetes. These are the majority of cases we hear about, make the evening news, or the morning papers. This blog on the Joslin blog site is one of the better discussions about the problems of correct diabetes diagnosis.

The next area of misdiagnosis in MODY being diagnosed as type 1 diabetes. I have blogged about some of the problems here and recommend you explore this site. What is even more of a concern is how some doctors feel about diabetes. I had one doctor (not one of mine thankfully) make a blanket statement that diabetes is diabetes and there in one simple treatment – give the patient insulin. He then continued it does not matter which type of diabetes the person has – insulin can treat them all. When he was asked by another person about people not needing medications or that could get off medication, he said if they had diabetes, all they needed to do was adjust the amount of insulin they injected. Other questions were asked, but the doctor was not budging from his pronouncement.

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