Purpose 

It is very important that people are accurately diagnosed with the right type of diabetes to ensure they receive appropriate healthcare.

There was a suspicion amongst healthcare professionals that some people identified with diabetes on practice registers might not have the condition and that those with diabetes may not have had the type correctly identified. . This view was reinforced by the effect of the 2006 Quality and Outcomes Framework (QOF) changes which required that diabetes be reported as Type 1 or Type 2 and saw a 22% reduction in the number of people on diabetes registers.

There was also evidence from the 2004-5 National Diabetes Audit report which identified that 43% of records did not specify the type of diabetes.

The aims of the project are to:

• Produce a specific set of recommendations about the clinical diagnosis and recording of all types of diabetes.
• Identify and agree a mechanism for recording the type of diabetes in a consistent way across England.

Leadership

The work is lead by a small working group, with the Royal College of General practitioners.

Approach

A facilitated initial meeting of stakeholders met to agree a consensus on the classification of type of diabetes:

• Types of diabetes workshop report (PDF 120KB)
• Diabetes workshop supporting document (PDF 226KB)
• Types of diabetes workshop supporting (PDF 558KB)

Achievements

The working group has now reported and their recommendations are available here:

Coding, Classification and Diagnosis of Diabetes (PDF 4.5MB)

• The systematic review reveals that miscoding, misclassification and misdiagnosis are prevalent throughout the world.
• The analysis of diagnostic databases reveals that people are miscoded, misclassified and misdiagnosed within primary care systems.
• A simple, easy to use, algorithm has been produced to provide guidance to healthcare professionals on a new diagnosis of diabetes.
• A series of data extraction queries based on the algorithm are available to enable GP practices to identify the extent of miscoding, misclassification and misdiagnosis within their existing diabetic population. These can downloaded from the Clinical Informatics Research Group website

Resources

• Report: Coding Classification and Diagnosis of Diabetes (PDF 2MB)
• Factsheet: Getting it Right Improving the Classification Diagnosis and Coding Diabetes (PDF 134KB)

NHS Diabetes Podcast: Classification of Diabetes with Dr. Kamlesh Khunti