Can clinical features be used to differentiate type 1 from type 2 diabetes? A systematic review of the literature
Open Access
- 2 November 2015
- Vol. 5 (11), e009088
- https://doi.org/10.1136/bmjopen-2015-009088
Abstract
Objective Clinicians predominantly use clinical features to differentiate type 1 from type 2 diabetes yet there are no evidence-based clinical criteria to aid classification of patients. Misclassification of diabetes is widespread (7–15% of cases), resulting in patients receiving inappropriate treatment. We sought to identify which clinical criteria could be used to discriminate type 1 and type 2 diabetes. Design Systematic review of all diagnostic accuracy studies published since 1979 using clinical criteria to predict insulin deficiency (measured by C-peptide). Data sources 14 databases including: MEDLINE, MEDLINE in Process and EMBASE. The search strategy took the form of: (terms for diabetes) AND (terms for C-Peptide). Eligibility criteria Diagnostic accuracy studies of any routinely available clinical predictors against a reference standard of insulin deficiency defined by cut-offs of C-peptide concentrations. No restrictions on race, age, language or country of origin. Results 10 917 abstracts were screened, and 231 full texts reviewed. 11 studies met inclusion criteria, but varied by age, race, year and proportion of participants who were C-peptide negative. Age at diagnosis was the most discriminatory feature in 7/9 studies where it was assessed, with optimal cut-offs (>70% mean sensitivity and specificity) across studies being Conclusions Despite finding only 11 studies, and considerable heterogeneity between studies, age at diagnosis and time to insulin were consistently the most discriminatory criteria. BMI, despite being widely used in clinical practice, adds little to these two criteria. The criteria identified are similar to the Royal College of General Practitioners National Health Service (RCGP/NHS) Diabetes classification guidelines, which use age at diagnosis Systematic review registration PROSPERO reference CRD42012001736.Keywords
This publication has 27 references indexed in Scilit:
- The clinical utility of C‐peptide measurement in the care of patients with diabetesDiabetic Medicine, 2013
- Standards of Medical Care in Diabetes—2013Diabetes Care, 2012
- Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)Diabetologia, 2012
- Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered ApproachDiabetes Care, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes MellitusClinical Chemistry, 2011
- A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected dataDiabetic Medicine, 2010
- Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone DiabetesDiabetes Care, 2006
- Estimating Prevalence of Type 1 and Type 2 Diabetes in a Population of African Americans with Diabetes MellitusAmerican Journal of Epidemiology, 1999
- Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose IntoleranceDiabetes, 1979