Pioneering calculator helps to prevent diabetes misdiagnoses

[DCUK NewsBot]

A calculator that combines health data and blood test results will help speed up diagnosing whether a person has type 1 or type 2 diabetes, researchers have said. A team from the University of Exeter developed the model to help prevent people from being wrongly diagnosed. The calculator is called the T1DT2D Prediction Model and is currently available online in 'beta format'. The calculator has been tested on more than 2,000 people and shown to be effective. The calculator is designed to be used by adults between the ages of 18 and 50 years old. Lead researcher Dr Angus Jones, of the University of Exeter Medical School, said: "The right diagnosis in diabetes is absolutely crucial to getting the best outcomes for patients, as treatment is very different in different types of diabetes. "However, in some people it can be very difficult to know what type of diabetes they have. Our new calculator can help clinicians by combining different features to give them the probability a person will have type 1 diabetes and assess whether additional tests are likely to be helpful." In May this year, Dr Jones published research showing that nearly 40 per cent of adults with type 1 diabetes were initially given the wrong diagnosis and treated for type 2 diabetes instead. A wrong diagnosis can lead to people being treated with the wrong medication for up to several years, which can lead to a greater risk of diabetes complications developing. The new calculator therefore helps to prevent this situation from occurring. The new calculator follows the success of another calculator developed by the university, one that determines the likelihood that someone diagnosed with diabetes may have a rarer form of diabetes called maturity onset diabetes of the young (MODY). The MODY Probability Calculator has already been used by more than 100,000 people and more than 9,000 people have downloaded the Diabetes Diagnostics phone app that includes the MODY calculator. The new type 1 diabetes probability calculator will be added to the Diabetes Diagnostics app. The research team from Exeter have published the methodology of developing and validating the model in the BMJ Open journal.

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[bulkbiker]

God forbid they would actually test something like insulin production.. that would be way too easy...
No instead let's invent a calculator that guesses it..

 

[ickihun]

Lovely.
It will definitely help me understand my diabetes better.
I know labels aren't needed but the correct treatment will stop me going blind.

I'm 4st+ lighter and still need insulin. A little novarapid but 24x triple dose basal units. As well as Metformin.
Metformin helps me with IR but insulin keeps my bgs in healthy levels. Even on low carb foods.

I cannot afford to disregard insulin if I want to keep my feet and eyes.

This test would be great for me. And my carers.

 

[TriciaWs]

Tried it, based just on my age and old style BMI and the fact that I've not had any of the tests it gave me 1%.
Not impressed.

 

[Antje77]

God forbid they would actually test something like insulin production.. that would be way too easy...
No instead let's invent a calculator that guesses it..

Insulin production isn't always enough to diagnose. High=T2. Very low or near absent=T1. Below normal to high normal=who knows?
And that's ignoring other types than 1 and 2...

 

[Deleted member 308541]

And that's ignoring other types than 1 and 2...

and people of ages above fifty and their ethnicity...

 

[Shiba Park]

Just might be of use for a GP who cannot accept a T1 possibility when the patient is 'too old' for it?

The calculator gave me a 50% chance of T1 using the minimum BMI of 17.5. My actual BMI at diagnosis was 15.3!. The app is considerably better than my GP...

Shiba.

 

[EllieM]

And that's ignoring other types than 1 and 2...

Well they've got another app that checks for MODY.

I think it's a good idea if only because it makes doctors reassess their old style T1/T2 assumptions. And it's only a beta test model.

It's still just making big assumptions about age/bmi (old/fat is T2) which we know is very simplistic, but we're talking about probabilities here, not individual facts. Their MODY calulator is a lot more nuanced, so hopefully this one will improve too.

Not sure why the cut off age is 50, seems a little young to me. I'll bet our ex pm was older than that when she became diabetic. (Just looked it up, she was 56.) But to be fair, this is the beta format.

 

[Member496333]

T2 could be confirmed or disconfirmed in the majority of cases with a simple insulin profiling test, but for whatever reason, the standard of care doesn't seem to want to acknowledge that such testing even exists. Instead, assumptions are made. I have my own thoughts on why this might be.

 

[Listlad]

It seems to be a step in right direction. It was this sort of thing that I was referring to in a thread just a few weeks back. If it helps to red flag the GP on a likely condition and then includes the best solutions it might surely help.

The thread was on whether or not GPs ought to know more than they do about diabetes diagnosis and care. Many said that as the GP is a general practioner that he or she could not be expected to know it all. Software like this can help plug that gap.

 

[DCUKMod]

As a general thought on all of these calculators and decision trees, it concerns me there is a temptation, for over worked, over stressed, sometimes under confident medics, to take the backstop of "the computer says", or the "calculator says".

We already have a system where many diagnoses are diagnoses of best guess or a diagnosis by elimination, meaning a correct diagnosis can sometimes take an uncomfortable amount of time to arrive at.

Please don't misunderstand me. I am keen for our medics to have a comprehensive tool set when it comes to making a diagnosis, but for complex conditions, and potentially complex conditions, we need more intellectual input than a few tick boxes.

 

[ickihun]

As a general thought on all of these calculators and decision trees, it concerns me there is a temptation, for over worked, over stressed, sometimes under confident medics, to take the backstop of "the computer says", or the "calculator says".

We already have a system where many diagnoses are diagnoses of best guess or a diagnosis by elimination, meaning a correct diagnosis can sometimes take an uncomfortable amount of time to arrive at.

Please don't misunderstand me. I am keen for our medics to have a comprehensive tool set when it comes to making a diagnosis, but for complex conditions, and potentially complex conditions, we need more intellectual input than a few tick boxes.

They do for baby deformation risks. And arrange abortions thereafter. Humf!!

 

[Listlad]

....but for complex conditions, and potentially complex conditions, we need more intellectual input than a few tick boxes.

We do. But I recall you were one that said that the GP’s know how on diabetes isn’t up to the mark (or words to that effect). Though I wouldn’t advocate complete reliance on such software, just a red flagging system. A sort of “whoa wait a minute Doc, this one might need a closer focus, going by what you just tapped in on the keyboard”. That sort of approach.

 

[KK123]

Why the cut off point at 50???

 

[KK123]

It's a poor state of affairs if a GP needs a calculator to work out what type a person is likely to be when all they have in front of them is age/weight/antibody test/whether they're white on the calculator.

 

[DCUKMod]

We do. But I recall you were one that said that the GP’s know how on diabetes isn’t up to the mark (or words to that effect). Though I wouldn’t advocate complete reliance on such software, just a red flagging system. A sort of whoa wait a minute Doc, this one might need a closer focus. That sort of approach.

Listlad, I would far rather a doctor I was consulting did some basic tests, frankly beyond often a single HbA1c to decide on their diagnosis, never mind their refined diagnosis "Diabetes > Type 2 Diabetes", for example.

I feel pretty certain few people diagnosed as having diabetes would ascribe the term typical to themselves. In my opinion, the term "typical" can be unhelpful at best.

 

[ickihun]

The most invaluable trait for any Dr should be not to judge a book by it's cover.
Even with diabetes.
OK a certain rash looks obvious to Dr's to be the result of the body's reaction to the ailment. Typical..... but with 'a disease' like diabetes its cause can come from a few quarters. Hence the confusion.

I will always stand by type2 diabetes is a liver disease, not cells sufficating the organs disease. Hence why thin people can hv IR. THIS IS ONLY MY OWN BELIEF not a medical one. Medically it has new discoveries added to Type2 diabetes which like any science it evolves into a more detailed disease. More causes, more variants and more influences. More chemicals and more complex.
Even i need a computor to tally every possibility.
They hv come up with some clever meds now too. Only to be given in direct circumstances. Those alone need an index. Yes let's computorise it but not neglect it when that info is old but continues to be relied upon.

 

[Circuspony]

Strange test. So I put in my height / weight / age that matched when I first visited the GP and it said 53% of T1. Add in the 2 positive antibody tests and 96% - which I think is stating the obvious!

When my GP finally realised they were wrong and send me to A&E. The consultant there has a tick list and the main one was the presence of ketones. His default was anyone with high BG and high ketones should be considered T1 unless tests down the line show otherwise.

 

[Robinredbreast]

Strange test. So I put in my height / weight / age that matched when I first visited the GP and it said 53% of T1. Add in the 2 positive antibody tests and 96% - which I think is stating the obvious!

When my GP finally realised they were wrong and send me to A&E. The consultant there has a tick list and the main one was the presence of ketones. His default was anyone with high BG and high ketones should be considered T1 unless tests down the line show otherwise.

Mine was 64% probability.
On admission to hospital I was down to 7 st 1, with all the symptoms of type 1 and the doctor who sent me there said he could smell pears drops on my breath, what happened regarding tests in hospital, I really don't know.

 

[Marie 2]

At the original time of diagnosis, it put my chance of being type 1 at 5%, if my doc had used this calculator I still would have been probably misdiagnosed. It seems like it still stands, if you are overweight at all you still must be a type 2. I don't see where this helps a whole bunch of the misdiagnosed out there.

I am not obese, but I am overweight. At the time I swam 75 laps in a gym pool, was a vegan and ate very healthy, had an uncle that had died from type 1, and they still didn't test me and assumed I was type 2. I believe because I wasn't skinny. It wasn't until I switched doctors that she tested me and I was properly diagnosed. That seems to be a common theme.

I hope this "calculator" doesn't go anywhere because it will be an excuse to misdiagnose more people.