Did You Receive The Correct Diabetes Diagnosis?

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If you agree that newly diagnosedpatients do not always receive advice on managing their diabetes,including testing information read my blogs here and here. Then youneed to wonder if patients are receiving the correct diagnosis. Thedisturbing factor is the misdiagnosed patients are not reported toany database. Often it is the patient, the doctor, and maybe a fewfamily members that ever know about the misdiagnosis. Yes, theinsurance carrier knows, but they generally will not release anyinformation. This should be a concern for any newly diagnosedpatient. The lack of a diabetes database and a database forimproperly diagnosed diabetes patients allows doctors to continuewithout problems or even a review by state practice boards.
This is disturbing because thisincludes all forms of diabetes, type 1, type 2, LADA, and MODY. Noone can say what the actual numbers are and that is the shame forpeople with diabetes. How can we put trust in the medical communitythat wants to keep this buried? Until states and the federalgovernment establish these databases and make reporting mandatory,this will continue to be a problem. Doctors will have no incentiveto be more careful in their initial diagnosis. These databases willalso need to available for review by diabetes patients to reportincidents of misdiagnosis for confirmation. These databases couldalso be valuable for other doctors and diabetes patients to determinethe number of misdiagnosed patients by doctor to discover reasons toquestion a diabetes diagnosis by the doctors with large numbers ofthese patients.
As I explained here, diabetes diagnosisis not as cut and dried, as many would think. I talked about many ofthe tests in this blog and it never hurts to review them. “Canthe A1c be used initially to screen for diabetes? Some doctors do useit for screening. Other doctors prefer a fasting blood glucose (FBG),the oral glucose tolerance test (OGTT), and the A1c before they willdiagnose diabetes. Another test in the diagnosis arsenal is thefasting plasma glucose (FPG) test. Still other doctors will use othertests to make sure it is type 2 and not type 1 or LADA. The C-peptideis also used to determine insulin resistance or the amount of insulinyour body is producing. Levels of autoantibodies to insulin and thebeta cells can be of some value but even these do not lead to anairtight diagnosis. This is because not all people with type 1 havethese antibodies. Therefore, the diagnosis is still largely aclinical one.”
I will also refer people to thiswebsite lab tests online dot org for a list of tests used fordiabetes. This has a discussion of - tests for screening, tests fordiagnosis, and tests for monitoring. I would urge people to know thedifferent tests and what their doctor used for their diagnosis. Notcovered is the tests for maturity-onset diabetes of the young (MODY)as this is a very specific and sometimes expensive test. Informationon MODY can be found here and the six types of MODY are listed in achart near the bottom of the page.
Most cases of misdiagnosis are peoplewith LADA being initially diagnosed as type 2 diabetes. These arethe majority of cases we hear about, make the evening news, or themorning papers. This blog on the Joslin blog site is one of thebetter discussions about the problems of correct diabetes diagnosis.
The next area of misdiagnosis in MODYbeing diagnosed as type 1 diabetes. I have blogged about some of theproblems here and recommend you explore this site. What is even moreof a concern is how some doctors feel about diabetes. I had onedoctor (not one of mine thankfully) make a blanket statement thatdiabetes is diabetes and there in one simple treatment – give thepatient insulin. He then continued it does not matter which type ofdiabetes the person has – insulin can treat them all. When he wasasked by another person about people not needing medications or thatcould get off medication, he said if they had diabetes, all theyneeded to do was adjust the amount of insulin they injected. Otherquestions were asked, but the doctor was not budging from hispronouncement.