'Is it all about NHS targets': It's a 21st Century epidemic, costing 1m an hour but experts fear thousands of the three million diabetes sufferers are misdiagnosed


Diane Platt was one of thousands who have been wrongly diagnosed

Diane Platt was one of thousands who have been wrongly diagnosed

After a bad fall in March 2010, Diane Platt was rushed to hospital in excruciating pain and wasn’t all that surprised to learn she had fractured her pelvis. But the 45-year-old, head of fundraising for a charity, wasn’t prepared for the bombshell the consultant then dropped: routine blood tests indicated she was suffering from type 2 diabetes.

‘In fact, the doctor who told me was incredulous that I wasn’t already being treated for the condition,’ says Diane, who lives in Bournemouth with husband Gary, 51, a chartered surveyor, and their son Rick, 24. ‘But I hadn’t been feeling unwell. In fact, I felt great – I’d just been on a skiing holiday.’

The diagnosis was a huge shock to Diane as she was fit and active and wasn’t classed as obese, considered one of the major risk factors in developing type 2.

But there was another surprise in store – when later she was told that she didn’t have diabetes at all. After the original diagnosis, and suspicious that something might be amiss, her GP carried out a further blood glucose test. She told Diane – a former nurse – that while she did have slightly high blood-sugar levels, she wasn’t suffering from the disease.

‘Her view was that the stress of my accident had probably raised my blood-sugar levels and the hospital consultant should have realised this and recommended that I had two subsequent tests once I’d recovered,’ Diane says.

Having been a slim size 12 for decades, Diane admits she had gained a few stone in recent years after being very ill with malaria and then having a hysterectomy. At the time of her fall, she was a size 16 – the national average.

‘I was still really active and did lots of walking,’ she adds. ‘Because my blood-sugar reading was only just within the healthy range, my GP suggested I follow a diet called Go Lower, based on low carbohydrate and high protein.’

Diane has since lost several stone. Most importantly, within a month of her altering her diet, her GP confirmed that her blood sugar was normal.

Alarmingly, her story is far from unusual. Earlier this year, The Royal College of General Practitioners and NHS Diabetes published evidence from an audit of five GP practices in Surrey, covering 45,000 patients.

Diabetes develops when the amount of glucose in the blood is too high because the pancreas doesn't produe enough orany insulin

Diabetes develops when the amount of glucose in the blood is too high because the pancreas doesn't produe enough orany insulin

It revealed that two per cent of those diagnosed with type 2 diabetes didn’t have diabetes at all – the equivalent of 50,000 misdiagnoses nationally. Some experts now believe this figure could be the tip of the iceberg.

‘We know people without symptoms are being diagnosed on the basis of just one test,’ says Dr Patrick Sharp, a consultant in diabetes and secretary of the Association of British Clinical Diabetologists. ‘We could be medicating people who never go on to develop type 2.’

According to charity Diabetes UK, the number of cases of diabetes in the UK has soared to 2.9 million, a 50 per cent rise since 2005, costing the NHS 9 billion a year, or 1million an hour. A staggering 130 million is spent just on tablets to control type 2, which accounts for 90 per cent of the 150,000 new diagnoses in the past 12 months.

Understandably, it has been heralded as the epidemic of the 21st Century. But now, questions are being asked about how sound many of these diagnoses actually are.

Actress Halle Berry suffers from diabetes

Actress Halle Berry suffers from diabetes

‘GPs aren’t always obeying the rules,’ says Dr Sharp. ‘The diagnostic criteria are complicated and open to confusion, even within the medical profession. There are guidelines to help which are not being followed.’

Diabetes develops when the amount of glucose in the blood is too high because the pancreas doesn’t produce enough – or any – insulin, the hormone that allows glucose to enter the body’s cells where it’s used as fuel.

In the short term, higher-than-normal amounts of glucose in the blood – typically in those with readings of ten or over – trigger blurred vision, unexplained weight loss, extreme fatigue and slow healing of wounds. Severe complications – blindness, kidney failure, infections, heart attack and stroke – can develop slowly over several years.

The most common means of detecting diabetes is a blood test taken after a patient has fasted overnight. Although finger-prick blood tests are still used by some GPs, they are not considered reliable.

A reading is given as a score that
refers to the amount of sugar per litre of blood. If a patient is
already experiencing common symptoms of diabetes, one blood test is
enough to confirm a diagnosis.

If
they’re symptom-free, two separate tests are required, and both would
need to register readings of seven or over. In a healthy individual,
blood sugar will fluctuate between three and seven, although this can
jump higher immediately after eating, returning to normal as the sugar
is naturally metabolised.

‘If
blood sugar is consistently over seven for more than five years, damage
to the blood vessels, arteries and circulation will occur,’ says Dr
Sharp.

The surge in
numbers developing type 2 diabetes can be tracked back to 1998 when the
World Health Organisation (WHO) lowered the threshold for diagnosing
diabetes using the fasting glucose test from 7.8 to 7. A year earlier,
there were 1.4 million people in the UK with diabetes. A report by the
Journal Of Epidemiology And Community Health revealed numbers rising
sharply by 400,000 between 1999, just after the diagnostic threshold had
been lowered, and 2003. So what’s going wrong ‘WHO guidelines state
that a person without diabetes symptoms cannot be diagnosed with type 2
unless two tests taken on different days each give a reading of seven
or above,’ says Dr Sharp.

‘If the first reading is 7.2 but the
second test returns 6.9, for example, the patient is in a grey area
sometimes referred to as pre- diabetes.

‘Diagnosing
on the basis of one test, as Diane was, is in breach of diagnostic
criteria. Of those people with a borderline reading of between 6.5 and
seven, 90 per cent will not go on to develop type 2 diabetes.’

According to charity Diabetes UK, the number of cases of diabetes in the UK has soared to 2.9 million, a 50 per cent rise since 2005, costing the NHS 9 billion a year, or 1million an hour. A staggering 130 million is spent just on tablets to control type 2, which accounts for 90 per cent of the 150,000 new diagnoses in the past 12 months.

A
further factor is thought to be the change to GPs’ contracts in 2004,
when Labour introduced the Quality Outcomes Framework (QOF) –
effectively, performance-related pay.

The
Government promised GPs cash incentives for diagnosing greater numbers
of serious conditions such as diabetes. The QOF also sets stringent
guidelines about effective treatment and doctors are further rewarded
when more than half their diabetic patients score blood-sugar levels
below seven – incentivising early drug treatment.

Dr Sharp adds: ‘GPs now screen for diabetes at an earlier stage. /01/07/article-0-0D699E8C000005DC-957_634x423.jpg” width=”634″ height=”423″ alt=”Many people are concerned that they may be misdiagnosed, you only have to check internet forums to find people who are discussing what they've been told by doctors” class=”blkBorder” />

Many people are concerned that they may be misdiagnosed, you only have to check internet forums to find people who are discussing what they've been told by doctors

On the diabetes.co.uk forum ‘Luminox’, a 67-year-old male writes: ‘Four weeks ago, after two fasting tests, my doctor announced I was diabetic. After my first test she said I was not diabetic but borderline. I reduced my sugar intake anyway and got myself a bike to ride 25 miles a week. After an improvement in my second test, which produced a lower reading, I was told I am diabetic. What am I supposed to believe I have no diabetes symptoms.’

Dr Sharp has been asked many times by GPs if they should prescribe the drug to those with a borderline reading. ‘The answer is no,’ he says. ‘Giving medication to those who don’t need it takes away personal responsibility for their health.’

Former nurse Simon O’Neill is director of care, information and advocacy at Diabetes UK and also believes many GPs are too quick to give a diagnosis and prescribe medication. ‘Sometimes it’s too easy to prescribe or take a pill. Patients should be given three months to change their diet and lifestyle before any medication is prescribed.’

The World Health Organisation is currently developing a more pragmatic, non-fasting blood test known as HbA1c. It will differ from the traditional blood-sugar test by revealing what the average glucose content in an individual’s blood has been for the previous six to eight weeks – but will still need to be repeated to avoid the possibility of human error.

Dr Sharp fears that introduction of the HbA1c could lead to further confusion – and experts have expressed worry that it will send numbers of diabetics spiralling.

‘There are some important caveats to using HbA1c,’ he says. ‘For example, because it measures haemoglobin, a patient who is anaemic or pregnant could have a falsely low reading when, in fact, they could be diabetic.

‘There will be a small number who will be diagnosed but who actually have a normal fasting blood-sugar level.’

He adds: ‘I do fear that the introduction of this test alongside the existing test will confuse the issue even more.’

Diane remains indebted to her GP for recognising her misdiagnosis. She tests sugar levels in her urine once a month at home, and readings have been consistently healthy.

‘Diabetes is not just a reading on a doctor’s chart,’ she says.

‘You have to declare it on insurance forms, which puts up your premiums, and notify the DVLA because medication may affect your ability to drive safely.

‘That’s fine if your treatment might save your life, but I resent that it might have been done simply to meet an NHS target.’