Intended for healthcare professionals


Diagnosis, classification, and treatment of diabetes

BMJ 2011; 342 doi: (Published 09 June 2011) Cite this as: BMJ 2011;342:d3319
  1. Andrew Farmer, professor of general practice1,
  2. Robin Fox, general practitioner2
  1. 1NIHR School for Primary Care Research, Department of Primary Health Care, University of Oxford, Oxford OX1 2ET, UK
  2. 2The Health Centre, Coker Close, Bicester, UK
  1. andrew.farmer{at}

Age of onset and body mass index are no longer a basis for classifying the cause

A recent report from the Royal College of General Practitioners and NHS Diabetes suggests that the diagnostic classification of 10-15% of patients with diabetes in general practice may be inaccurate, and that this may have a considerable effect on patient care.1 The report proposes a new approach to the classification of different types of diabetes and calls for greater efforts in checking the accuracy of diagnoses, along with efforts to improve education and classification in primary care. Are these concerns justified, and are the solutions proposed practical?

The stereotypes of the older obese patient with gradually rising blood glucose and the younger non-obese patient presenting acutely and requiring immediate treatment with insulin are no longer sufficient to classify people as having type 1 or type 2 diabetes. Conventional criteria for diagnosis include age of diagnosis, presence of ketoacidosis, and body mass index. However, with increasing obesity in younger people, the wider use of insulin for type 2 diabetes, and an awareness of the existence of genetic forms of diabetes, there is concern about the risk of misclassification and misdiagnosis, with adverse consequences. The report provides evidence that these concerns are justified.

The report provides two strands of evidence that suggest an important problem. …

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