Translation of the recommendations for the diagnosis of diabetes mellitus into daily clinical practice in a primary health care setting.
OBJECTIVE
to assess the implementation of 1985 recommendations for the diagnosis of diabetes (World Health Organization [WHO]) in a primary care setting, and the physician's attitude toward the diagnosis of diabetes mellitus (DM).


METHODS
Subjects with a fasting plasma glucose (FPG)>6.1 mmol/l (> or =110 mg/dl) and with previously unknown glucose tolerance status were identified retrospectively in a primary health care center during a 45-month period. The following variables were evaluated: anthropometric parameters, fasting plasma glucose and oral glucose tolerance test (OGTT) values, registration of a diagnosis of diabetes in clinical records, smoking status, lipid profile and blood pressure.


RESULTS
1181 subjects with a FPG>6.1 mmol/l were identified (target population): 171 with a FPG>7.8 mmol/l and 1010 with a FPG between 6.1 and 7.7 mmol/l. In the latter group, an OGTT was performed in 553 subjects (54.8%) (173 yielded a diagnosis of diabetes). During the study period, diabetes was diagnosed in 29.1% (n=344) of the target population. Following the 1985 WHO recommendations, a confirmatory diagnostic test was repeated in 92 (69.7%) subjects with a FPG between 7.8 and 11.0 mmol/l, and in 132 subjects (23.87%) who had already received an initial OGTT. The analysis of the diagnostic process followed by the different physicians revealed a high interindividual variability in terms of: proportion of cases diagnosed as diabetes by an OGTT (from 35.7 to 65.2), percentage of subjects with a FPG 6.1-7.7 mmol/l without an OGTT (7.33-70.27%), proportion of confirmatory OGTTs (0-57.89%), and percentage of misdiagnosed cases (1.16-6.34%). The percentage of subjects misdiagnosed was negatively correlated with the proportion of OGTT repetitions.


CONCLUSIONS
1985 WHO recommendations for the diagnosis of diabetes are only partially followed at a primary health care level. There is a high interindividual variability among physicians in the implementation of these recommendations that is associated with the misdiagnosis of diabetes.
Servei de Diabetis, Endocrinologia i Nutrició, Hospital de Sabadell, Corporació Parc Taulí, s/n 08208 Sabadell (Barcelona), Spain. jmgonzalez@cspt.es
J M
JM
González-Clemente
G
G
Galdon
J
J
Mitjavila
A
A
Miñarro
G
G
Giménez-Pérez
D
D
Mauricio
D001291:Attitude of Health Personnel; D003920:Diabetes Mellitus / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011320:Primary Health Care; D013030:Spain; D014944:World Health Organization