Why is Diagnosing T1 Diabetes so hard for GPs?

 

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Diabetes Dad is launching a campaign to improve the diagnosis of type 1 diabetes in primary care in the US. This is much needed, not only in the US, but also Australia. Despite being one of the most common diseases of childhood(Australian Institute of Health and Welfare 2009), too often children are diagnosed with flu and sent home with an aspirin, only to re-present in critical condition a few weeks or days later.

My family’s story is of how, despite, several WEEKS of visiting doctors, a diagnosis of teething and finally an admission to hospital where they gave me milkshakes and didn’t bother to test my urine or blood for sugar (no thanks Hornsby Hospital) I nearly died at 16 months of age from DKA. I was projectile vomiting, turning blue (I think I was the inspiration for that Exorcist movie) and having difficulty breathing when Mum demanded action and she and Dad were advised by doctors to drive me almost 30 kilometres from Hornsby Hospital to the Kids hospital in Camperdown (and yes, it was peak hour on a Friday night)

That was 40 years ago but sadly, it appears things have not improved.  Anecdotes about misdiagnosis are common, not only for children but also for adults with type 1.  A national survey conducted in 2010 by the Type 1 Diabetes Network of over 850 adults diagnosed with type 1 as adults found that one in three were diagnosed with something other than diabetes when they visited their primary care physician/General Practitioner. Over two thirds of those who were misdiagnosed the first time had to return another 2 or more times before receiving a correct diagnosis and treatment for a life-threatening condition.

This isn’t acceptable. The symptoms of diabetes are well known, it is a relatively common disease and every GP has the ability to diagnose type 1 diabetes in their office. So why aren’t they conducting a cheap and absolutely pain free urine test for sugar and ketones and/or a finger prick blood glucose test for patients presenting with flu-like symptoms? Why aren’t GPs asking about symptoms such as polyuria, excessive thirst and hunger and weight loss?

It's not rocket science, equipment needed to diagnose diabetes.
It’s not rocket science, equipment needed to diagnose diabetes.

I struggle to understand why diagnosing type 1 is so difficult, but it appears to be so and requires more education for GPs.  The Australian government committed $872 million to health campaigns from 2010 to prevent type 2 diabetes (Link to Australian Government webpage ) this is admirable and I don’t begrudge it at all, but less than 1% of that amount could fund an education campaign for GPs to make sure that people are diagnosed with type 1 diabetes on their first visit to a primary care doctor. This would be extremely cost-effective, it would save the government the cost of multiple GP visits and the extremely expensive and intensive treatment necessary to restore somebody’s health when they are in a ketoacidotic coma or extremely acidotic state.  Our diabetes organisations are funded by taxpayers to conduct programs through the National Diabetes Supplies Scheme, again only a small portion of this could make a significant difference to the 25,000 GP’s knowledge of type 1 diabetes.

2 thoughts on “Why is Diagnosing T1 Diabetes so hard for GPs?

  1. Yep, one of the GP misdiagnosed here (candida, type 2) before eventually being diagnosed T1 by a vigilant anaesthetist. Knowing what I know now I am still staggered that I had to even ask for the diabetes test in the first place and the GP’s naive assumption after results that because I was 37 that I must be T2. If GPs cannot get it right by asking a few simple questions/tests at the outset, they’re hardly going to be much value in assisting folks to manage the illness either…I have a new GP, obviously! But my experiences makes me more active myself in understanding things and having high expectations of the health practitioners I engage in a support role.

  2. Thanks for your comment but sorry to hear of another misdiagnosis story. I think the only way to survive as a type 1 is to be incredibly proactive and not to trust that any HCP really knows anything about type 1 until they prove otherwise, then I might engage them in a support role . Sad but true unfortunately.
    Mel

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