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Erroneous Diabetes Diagnosis

(pdf) Erroneous Diabetes Diagnosis: A Case Of Hba1c Interference

(pdf) Erroneous Diabetes Diagnosis: A Case Of Hba1c Interference

Diabetes Care Publish Ahead of Print, published online August 20, 2015 Hamilton, The Bailey Clinic, Red Deer, Alberta, Can- ada, for administrative assistance. Genetic testing was performed by the Hamilton Regional Labora- tory Medicine Program, Hamilton, Ontario, Canada. Duality of Interest. No potential conicts of interest relevant to this article were reported. data and wrote the manuscript. K.R.-C. and T.N.H. discovered the interference, contacted ordering physicians, researched the data, and reviewed and edited the manuscript. M.P.E. and V.E.B researched the data, contributed to the discussion, and reviewed and edited the man- uscript. G.R.B. and L.M.M. provided patient clinical information, obtained patient informed consent, recruited patient relatives for Hb in- vestigation studies, and reviewed and edited the manuscript . K.R. -C. is the guar an to r of this work and, as such, had full access to all the data in the study and takes respo nsibility fo r the integrity of the data and the accuracy of the data 1. Goldenberg R, Punthakee Z; Canadian Diabe- tes Association Clinical Practice Guidelines Expert Committee. Denition, classication and diagno- sis of diabetes, prediabetes and metabolic syn- drome. Can J Diabetes 2013;37(Suppl. 1):S8S11 2. American Diab etes Association. Classi ca- tion and diagnosis of diabetes. In Standards of Medical Care in Diabetesd2015. Diabetes Care 3. Moo-Penn WF, Jue DL, Johnson MH, et al. Structural and functional studies of hemoglobin Wayne: an elongated alpha- chain variant. J Mol 4. Brennan M, Luzzi V, Whitehouse F, Farahani P. Inaccurate hemoglobin A1c values in the presence of hemoglobin Wayne variant. Late- breaking abstract presented at The Endocrine 5. Sacks DB, Arnold M, Bakris GL, et al.; National Academy of C linica l Bio Continue reading >>

7 Mistakes Doctors Are Making With Diabetes

7 Mistakes Doctors Are Making With Diabetes

A few years back I was caring for my cousin who suffered from diabetes. During this time, I learned a lot about mistakes doctors are making with diabetes. Now, this isn’t to put down doctors in any way. Doctors are people too. My cousin wasn’t very good at talking to his doctor and this contributed to medical error as well. My cousin was diagnosed in his twenties with Type 1 Juvenile Diabetes. The period of time in the 20’s is a gray area between Type 1 and Type 2 diabetes. It can still be one or the other. It was pretty obvious it was Type 1 since there was a strong family history and we are Native American – as you probably know already, Native Americans are at a greater risk for developing diabetes. We knew his diagnosis was correct, plus he needed insulin. He had a very good physician who had been treating our entire family for endocrine disease for many years. Then, my cousin moved away and got a new job. He did the normal thing anyone would do when moving; he ordered his records and found a new physician. This led to a whole slew of miscommunications and treatment changes that led to my cousin going downhill. Here are a few things that could go wrong with your diabetes treatment: 1. Type 1/Type 2 Diabetes Confusion This can happen either early on in your diagnosis of diabetes or if you switch medical providers. Even if you are admitted to the hospital, there may be changes in your records or care for the wrong type. Explanation: My cousin was first diagnosed with Type 2 diabetes as his pancreas were still working some. His first doctor realized that he did in fact have Type 1 diabetes and noted that in his chart. When he moved, he handed over his records to his new doctor. The new doctor only looked at the first few pages of his chart and presumed he had T Continue reading >>

Diabetes Diagnosis Of The Future: 11 Types?

Diabetes Diagnosis Of The Future: 11 Types?

Diabetes Diagnosis of the Future: 11 Types? Commentary by Stanley S. Schwartz, MD, an emeritus associate professor of medicine at the University of Pennsylvania and George Grunberger, MD, FACP, FACE, chairman of the Grunberger Diabetes Institute, clinical professor of internal medicine and molecular medicine & genetics at Wayne State University School of Medicine and president of the American Association of Clinical Endocrinologists. Diabetes isnt as simple as doctors and researchers once believed. Theres lots of overlap between type 1 and type 2 people can have features of both yet their doctors dont always treat them with that in mind, says endocrinologist Stanley S. Schwartz, MD, an emeritus associate professor of medicine at the University of Pennsylvania. "Treatment algorithms and insurance rules get in the way too often. Fed up and looking for a constructive solution, Dr. Schwartz and his colleagues have published an article in the February issue of the journal Diabetes Care, proposing a new way to classify this increasingly common high blood sugar problem based on factors that threaten insulin-producing beta cells in the pancreas. If beta cells cant secrete enough insulin to control blood glucose, you have high blood sugar and diabetes, he says. Were saying that you have to look more closely at why thats happening. Everything from auto-immune reactions to insulin resistance to gut bacteria can play a role. We are suggesting that doctors look for these factors and develop treatment plans that target each persons unique, beta cell-centric profile. Dr. Schwartz acknowledges that a new diabetes-diagnosis system wouldnt happen overnight. Were calling on major diabetes and endocrinology organizations in the United States and Europe to support research, he told Endocri Continue reading >>

A Flawed Reference In Assessing Diagnostic Accuracy Leads To Erroneous Conclusions

A Flawed Reference In Assessing Diagnostic Accuracy Leads To Erroneous Conclusions

A flawed reference in assessing diagnostic accuracy leads to erroneous conclusions Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions BMJ 2017; 356 doi: (Published 04 January 2017) Cite this as: BMJ 2017;356:i6538 A flawed reference in assessing diagnostic accuracy leads to erroneous conclusions We read with interest the findings from Barry et al on the optimal screening test that should be used to identify people at risk of developing type 2 diabetes (1). Three testing modalities are evaluated; fasting plasma glucose (FPG), the oral glucose tolerance test (OGTT) and HbA1c. Unfortunately, the analysis presented is severely limited by methodological flaws. Which test best identifies non-diabetic hyperglycaemia is the wrong question to ask. It is well known that non-diabetic hyperglycaemia includes people with various dysglycaemic aetiologies (2,3); encompassing fasting hyperglycaemia, impaired glucose tolerance, and a raised HbA1c concentration (which may not overlap with glucose criteria). Importantly, the individual test identifying each of these states does not necessarily correlate with the cut-offs applied for the identification of the other states (4). None of these states are mutually exclusive, but crucially, all of these states have been independently associated with microvascular complication risk (3,5). The diagnosis of non-diabetic hyperglycaemia only has real meaning if it identifies those at high risk of diabetes, and micro- and macrovascular complications, and there is some evidence that HbA1c is better, certainly for predicting macrovascular complications(5). The tests additionally may each identify different people within the spectrum of non-d Continue reading >>

Asknadia: Is My Low Carb Diet Causing A False Pre Diabetes Diagnosis

Asknadia: Is My Low Carb Diet Causing A False Pre Diabetes Diagnosis

Dear Nadia, When you are loosing weight on a low carb diet, does this artificially inflate my pre-diabetes glucose test? Paula Corin Linnwood WA Dear Paula, Pre-diabetes statistics have been in the news for several years with great concern for our national population. It is great that you are staying on top of your health and paying attention to your diet to be one less number in the growing diabetes population. The annual increase in pre-diabetes diagnosis is growing at an alarming rate. In 2010, 79 million people were diagnosed with pre-diabetes. Two year later, in 2012, this number grew to 86 million people . The Center for Disease Control and Prevention reports within a five year period, 15-30% of the people diagnosed with pre-diabetes will be be diagnosed with type 2 diabetes. This translates into anther 12.9 to 25.8 million people who are coming up through ranks with a diabetes diagnosis from 2012. What is Pre-diabetes Pre-diabetes is when your blood sugar test reads higher than normal but not high enough to be diagnosed with diabetes. Does a Low Carb Diet Give You a False Pre-diabetes Diagnosis If you take a glucose tolerance test and are eating under 300 carbs a day for three days prior to the test; yes you can get a false diabetes or pre-diabetes diagnosis. Typically when you eat food, the GLP-1 hormone in your body simulates the secretion of the insulin hormone to convert food into energy. With a low carb diet your body secrets less insulin and turns to your reserves to metabolize the fat for energy. Why You Get a False Pre-diabetes Diagnosis A low carb diet will create a slow uptake of insulin which shows a false elevated glucose. It metabolizes your fat reserves. Dr Richard Bernstein, a famous low carb diet advocate and a person with type 1, tells me we can Continue reading >>

Wrong Diabetes Diagnosis.

Wrong Diabetes Diagnosis.

On Monday, the Wall Street Journal (look at me, linking to a real publication instead of a Strongbad email) had an article about doctors misdiagnosing type 1 diabetes in adults. I posted a link to the article, called "Wrong Call: The Trouble Diagnosing Diabetes," on my Facebook page and received several comments from people who went through a similar misdiagnosis. They have offered to share some of their story here, and I'm hopeful that their words will help someone else in a similar situation. The Initial Symptoms. Jessica, diagnosed at age 26, was already familiar with type 1 diabetes. "My diagnosis story actually begins with my husband, diagnosed with type 1 on his 21st birthday. Fortunately he was diagnosed correctly and quickly, and we were able to get him all of the help he needed." She described hitting a wall of thirst and exhaustion that set in when her son was nine months old. "These symptoms continued for about a week, and mostly only bothered me at night. During the day, although I was tired, I wasn't going to the bathroom constantly or super thirsty." Lindsay had a similar experience, just before she turned 27. "I was just a few weeks s hy of my 27th birthday. I had been sick a long time with weight loss, hair loss, you name it. I ended up with intense upper GI pain that couldn't be ignored, so my mom took me to the ER where the symptoms were investigated with an ultrasound, blood work, etc. The doctor came back to report that I had 'viral gastritis, likely due to your increased blood glucose level, which is 277. Now, because of your age, you'll be considered a type 2.' Love that one, eh?? My mom and I sat stunned; my dad had JUST been diagnosed with type 2 three weeks before." Sarah also sang the same symptoms tune: "The morning of February 22, 2007 I woke Continue reading >>

100,000 'received Wrong Diabetes Diagnosis'

100,000 'received Wrong Diabetes Diagnosis'

100,000 'received wrong diabetes diagnosis' Around 100,000 people in England have been diagnosed with the wrong type of diabetes or told they have the disease when they do not, according to research. A report found "substantial evidence" that people are being miscoded, misclassified and misdiagnosed with diabetes on GP lists. For every 500 people identified with diabetes on a GP register, about 65 to 70 could need to be looked at again for some sort of error. Experts from the Royal College of GPs and NHS Diabetes have now published new guidance aimed at improving the way the disease is recorded. One of the experts behind the report, Professor Simon de Lusignan from the University of Surrey, said the team accepted around 50,000 people are diagnosed with diabetes but do not have it, and another 50,000 are classified with the wrong type. This means some people will have been told they have Type 2 diabetes when in fact they have Type 1, and vice versa. Some of the errors are caused by mistakes made when entering information, but some are down to a lack of understanding among doctors or other staff, the report said. The growth in obesity has also made it more difficult to differentiate between Type 2, which is linked to unhealthy lifestyles, and Type 1. Such errors can have a "considerable impact on patient care" while "accurate diagnosis is critical for the appropriate treatment for the person with diabetes", the report said. It said "the most widespread misunderstanding" among health professionals was changing somebody's diagnosis from Type 2 to Type 1 when they go on to insulin. "This, potentially, could have a considerable impact on patient care as the guidelines for insulin use in Type 2 are very different from those in Type 1." Pilot audits from five GP practices in S Continue reading >>

Pre-diabetes Diagnosis Has Little Value, Say Two Experts

Pre-diabetes Diagnosis Has Little Value, Say Two Experts

Millions of people are being needlessly diagnosed with “pre-diabetes,” putting them at risk of receiving “unnecessary” medical treatment and creating “unsustainable burdens” for health care systems, according to a commentary published last week in the journal BMJ. Written by Dr. Victor Montori, an endocrinologist who specializes in diabetes at the Mayo Clinic in Rochester, and Dr. John Yudkin, an emeritus professor of medicine at University College London, the commentary describes the dubious origins of the “pre-diabetes” label and its unreliable role as a predictor of who will go on to develop diabetes. “Pre-diabetes is an artificial category with virtually zero clinical relevance,” says Yudkin in a press statement released with the commentary. “There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway.” “Rather than turning healthy people into patients with pre-diabetes, we should use available resources to change the food, education, health, and economic policies that have driven [the obesity and diabetes] epidemic,” he and Montori write in their commentary. Yet the “pre-diabetes” label has been attached to one-third of adults in the United States — and half of those living in China. Changing the terms As Yudkin and Montori point out, “pre-diabetes” is an umbrella term created in recent years to describe blood sugar levels that are higher than normal but below those that define diabetes. The term was coined by the American Diabetes Association (ADA), and is widely used in the United States and in global scientific literature. The World Health Organization, however, discourages its use, and urges Continue reading >>

Why Is Type 1 Diabetes Misdiagnosed?

Why Is Type 1 Diabetes Misdiagnosed?

Many people with Type 1 share a similar diagnosis story. They display all the classic symptoms (extreme thirst, weight loss, frequent urination, nausea) and were fortunate enough to be accurately diagnosed by their primary care doctor. However, some people with Type 1 are not as fortunate to quickly receive a correct diagnosis. It is important to remember that the only way to have an accurate diagnosis of Type 1 diabetes is to test for the diabetes-related (islet) autoantibodies. If ICA, GADA, and/or IA-2A are present in a person with diabetes symptoms, then you have confirmation that the diagnosis is Type 1 diabetes. If IAA is present in a child with diabetes who is not using insulin, then the diagnosis is Type 1 instead of Type 2. If no diabetes-related autoantibodies are present, then it is unlikely that the diagnosis is Type 1 diabetes. Only in extremely rare incidents does someone have Type 1 and does not develop detectable amounts of islet autoantibodies. Some people who have Type 1 diabetes will never develop detectable amounts of islet autoantibodies, but this is rare. Approximately, 95% or more of people with new-onset Type 1 diabetes will have at least one islet autoantibody (labtestsonline.org). The following are some conditions and ailments that people are often misdiagnosed with after first experiencing symptoms of Type 1 diabetes. A misdiagnosis can be extremely dangerous and in some cases, fatal. Type 2 diabetes A common misdiagnosis is the other “type”: Type 2 diabetes, as most of the early symptoms are the same or very similar to that of a Type 1 diagnosis. Depending on your current state of health, weight fluctuations, eating habits, and other factors – a medical professional may wrongly assume that you are suffering from Type 2. Read Grace Bonne Continue reading >>

Screening For Type 2 Diabetes

Screening For Type 2 Diabetes

CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 POSITION STATEMENT AMERICAN DIABETES ASSOCIATION Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes, the most prevalent form of the disease, is often asymptomatic in its early stages and can remain undiagnosed for many years. Approximately 5.4 million adults in the U.S. have undiagnosed type 2 diabetes. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Individuals with undiagnosed type 2 diabetes are at significantly higher risk for coronary heart disease, stroke, and peripheral vascular disease than the nondiabetic population. They also have a greater likelihood of having dyslipidemia, hypertension, and obesity. Because early detection and prompt treatment may reduce the burden of type 2 diabetes and its complications, screening for diabetes may be appropriate under certain circumstances. This position statement provides recommendations for diabetes screenings performed in physicians' offices and community screening programs. This position statement does not address screening for type 1 diabetes or gestational diabetes mellitus (GDM). Because of the acute onset of symptoms, most cases of type 1 diabetes are detected soon after symptoms develop. Widespread clinical testing of asymptomatic individuals for the presence of autoantibodies related to type 1 diabetes cannot be recommended at this time as the means to identify persons at risk. Reasons for this include the following: 1) cutoff values for some of the immune marker assays have not been completely established for clinical set Continue reading >>

My Diabetes Was Misdiagnosedand It's A Lot More Common Than You'd Think

My Diabetes Was Misdiagnosedand It's A Lot More Common Than You'd Think

My Diabetes Was MisdiagnosedAnd It's A Lot More Common Than You'd Think The diagnosis from my primary care doctor was type 2 diabetes, but the specialist sitting across from me could tell that was wrong just by looking at me. I was 33 years old and slim, a new mom who'd been diagnosed with gestational diabetes while pregnant. All the hard work I'd been doing for the last year to control my blood sugar levelsfitness boot camp, a diabetic diet with drastically reduced carb intakewasn't working anymore, so I'd booked an appointment with Jessica Castle, MD, an endocrinologist at the Harold Schnitzer Diabetes Health Center of Oregon Health and Science University. Castle told me I didn't have type 2 diabetes, the kind characterized by insulin resistance, where the body's cells are unable to fully use the insulin the pancreas makes. I had type 1 diabetes, an autoimmune disease that destroys the beta cells of the pancreas that produce insulin. MORE: 9 Everyday Things Making Your Gut Really Unhappy "It's OK," said Castle, handing me a box of tissues. "You're not the first person to cry in this office. You're not even the first person to cry in this office today." Type 2 diabetes, tied to obesity and genetic predisposition, has become an epidemic in the United States. Ninety to 95% of all 30 million diabetes cases are type 2. Type 1 diabetes is less common, representing approximately 5% of cases, with most of those surfacing during childhood. But those numbers may not be entirely accurate: A 2005 study found that about 10% of those over age 40 diagnosed as type 2 actually tested positive for the antibody cells associated with type 1 diabetes. For those younger than 35, the rate was closer to 25%. Castle says her practice sees multiple cases every year of people misdiagnosed with Continue reading >>

When To Use Fasting Glucose To Diagnose People With Type Ii Diabetes

When To Use Fasting Glucose To Diagnose People With Type Ii Diabetes

Until recently, fasting plasma glucose, and in some situations, oral glucose tolerance testing, have been the investigations of choice for diagnosing people with type II diabetes. Recently, recommendations in New Zealand have changed and HbA1c has become the primary assay for diagnosing type II diabetes, along with its continued role in monitoring glycaemic control. However, there are some clinical scenarios where HbA1c is unreliable, and fasting plasma glucose should be used in preference View / Download pdf version of this article HbA1c is the recommended test for diagnosing type II diabetes in most situations In September, 2011, the New Zealand Society for the Study of Diabetes (NZSSD) changed its recommendation regarding choice of test for diagnosing type II diabetes, stating that glycated haemoglobin (HbA1c) was the preferred test over fasting glucose.1 In addition, it is now recommended that HbA1c is the test of choice for population screening programmes.2 However, there are some scenarios where measuring HbA1c for diagnostic purposes may give misleading or inaccurate results (see bullet list and Table 1 below), and therefore a fasting plasma glucose is recommended.1 Oral glucose tolerance testing (OGTT) is no longer recommended for most people as a test for type II diabetes.2 N.B. OGTT is still used for diagnosis of women with gestational diabetes. For further information on the change in guidance and the use of HbA1c, see: "The new role of HbA1c in diagnosing type 2 diabetes", BPJ 42 (Feb, 2012), and "Understanding the new HbA1c units for the diagnosis of Type 2 diabetes" Braatvedt G et al, NZMJ 2012;125(1362). HbA1c results may be misleading in some people and situations Fasting plasma glucose should only be used to test for type II diabetes in situations when Continue reading >>

The Glucose Vs. Hba1c Controversy

The Glucose Vs. Hba1c Controversy

Which test should be used for the diagnosis of diabetes: glucose or HbA1c? Over the last few years, an increasing number of countries have moved from fasting plasma glucose to HbA1c as the method of choice. The measurement of glucose, which goes back more than 100 years, far pre-dates HbA1c, and it can be argued that it measures the analyte that is widely known as being central to diabetes. Hemoglobin does not have so strong a pedigree as a diabetes diagnostic. The red protein that transports oxygen from the lungs to the tissues and carbon dioxide back to the lungs is an artifact, or at most an indirect measure, of average glucose. HbA1c testing has historically been recommended only to determine glucose control in those who already have been diagnosed as diabetic. Why, then, are we seeing an increasing move toward measuring HbA1c rather than fasting plasma glucose as the diagnostic test for diabetes? Some relevant background The red blood cell has an average circulating life of some 120 days. The cell membrane allows some reagents to cross into the cell. These so-called penetrating solutes include glucose, urea, bicarbonate, phosphate, and water. Hemoglobin, which is highly concentrated within the cell, reacts with free glucose to form glycated hemoglobin. The main glycation site is at the N-terminal valine of the beta chain. The term HbA1c refers to glycation at this specific site. Hemoglobin is also glycated at a number of €-amino lysines such as ß-66, α-16, and ß-17, and also on the alpha N-terminal valine.1 In 1969 Samuel Rahbar, an Iranian scientist, was the first to report the linkage between diabetes and HbA1c.2 He showed a band migrating ahead of HbA (toward the cathode) using agar gel electrophoresis at pH 6.2. This band had the same chromatographic mobil Continue reading >>

Understanding A Type 2 Diabetes Diagnosis

Understanding A Type 2 Diabetes Diagnosis

Diagnosing Type 2 Diabetes Type 2 diabetes is a manageable condition. Once you’re diagnosed, you can learn what to do to stay healthy. Diabetes is grouped into different types. The most commonly diagnosed are gestational diabetes, type 1 diabetes, and type 2 diabetes. Gestational Diabetes Maybe you have a friend who was told she had diabetes during pregnancy. That type is called gestational diabetes. It can develop during the second or third trimester of pregnancy. Gestational diabetes usually goes away after the baby is born. Type 1 Diabetes You may have had a childhood friend with diabetes who had to take insulin every day. That type is called type 1 diabetes. The peak age of onset is in the midteens. According to the Centers for Disease Control and Prevention (CDC), type 1 makes up 5 percent of all cases of diabetes. Type 2 Diabetes Type 2 diabetes makes up 90 to 95 percent of all diagnosed cases of diabetes, according to the CDC. It is also called adult-onset diabetes. Although it can occur at any age, it’s more common in people older than 40. If you think you might have diabetes, talk to your doctor. Uncontrolled type 2 diabetes can cause severe complications, such as: amputation of the legs and feet blindness heart disease kidney disease stroke According to the CDC, diabetes is the 7th leading cause of death in the United States. People with diabetes are 1.5 times as likely to die as people of the same age who don’t have diabetes. Many of the severe side effects of diabetes can be avoided with treatment. That’s why it’s so important to be diagnosed as soon as possible. Some people are diagnosed with type 2 diabetes because they have symptoms. Early diabetes symptoms include: increased or frequent urination increased thirst fatigue cuts or sores that won Continue reading >>

How Diabetes Is Diagnosed

How Diabetes Is Diagnosed

A few simple tests can reveal if you have diabetes (blood sugar levels that are above 200 milligrams per deciliter) or prediabetes (blood sugar levels above 140 mg/dl). What it is: After you fast for at least 8 hours, you'll undergo a simple blood test that measures the amount of sugar in your bloodstream. Pro: It's widely available (it'll probably be included in your standard physical) and not too expensive. The results are also pretty reliable, assuming you complete the required fast. Con: If you eat when you're supposed to be fasting, the test could give false positives or negatives. For example, coffee is often allowed during the fast, but just adding a dash of cream to your cup can throw off test results. What it is: After fasting for at least 8 hours, you drink a sugary solution akin to super-concentrated soda (without the fizz). Frequent blood tests measure your glucose levels over the next 2 or more hours. Pro: It's the most accurate diagnostic test. Con: Frankly, who wants to sit in the doctor's office all day? What it is: Similar to the fasting glucose test, but, of course, without the fasting. Con: It's not actually sanctioned as a diagnostic test for diabetes, so it's likely that you'll be asked to make a return visit for a second test to validate the results. What it is: A blood test that measures blood glucose levels in your red blood cells, which live in your bloodstream for about 3 months. Pro: It's the most comprehensive test to diagnose diabetes. Each red blood cell can reveal how much blood glucose was attached to it over its 3-month lifespan, serving as a calendar of your average blood glucose levels. Con: It's not technically considered a diagnostic testyet. But in April 2009, an expert panel comprised of representatives from the American Diabetes Continue reading >>

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