R.D. Hauck1, A.T.H. Heijneman2, H.E. Hart3, M.G.J. Willink3, P. Dogger-van Nieuwenhoven3, E.J.P. de Koning, M.A. Schroijen1
1Department of Internal Medicine, Leiden University Medical Centre, Leiden; 2Institute of Cultural Anthropology and Development Sociology, Leiden University; 3Stichting Langerhans, The Netherlands
r.d.hauck@lumc.nl
Background: 5-11% of all patients with diabetes do not have type 1 or type 2 diabetes, but an atypical subtype such as Maturity Onset Diabetes in the Young (MODY). Frequently, these subtypes are diagnosed incorrectly. This has relevant implications for treatment, risk for diagnosis-related co-morbid conditions, information for relatives, and costs. Diagnosing monogenic diabetes is cost-effective, yet there is a lack of tools in primary care for adequately diagnosing atypical diabetes. In 2022 we launched the toolbox Atypical Diabetes to raise awareness of and improve precision diabetes diagnosis. Our primary goal was to evaluate its usefulness and implementation in routine primary clinical care.
Methods: A survey and semi‑structured interviews were performed for evaluation of the toolbox using a mixed methods design. The survey included questions on diabetes diagnosis and implementation of the toolbox, with opinions rated on a 7-point Likert scale. The Think Aloud Method was implemented in interviews. Findings were discussed in a focus group according to the principles of Synthesized Member Checking. Qualitative data were analyzed through inductive thematic analysis. Primary endpoints were toolbox use, usability, and general opinion.
Results: 175 GPs/PNs filled in the survey. In their practices, diabetes was diagnosed by GPs (48%), PNs (37%), or both (15%). 89% of GPs/PNs felt competent at diagnosing type 2 diabetes, but only 35% felt equally competent at diagnosing other diabetes subtypes. Although 73% of GPs/PNs were unfamiliar with the toolbox prior to the survey, 91% would recommend it to colleagues and 92% would use it in future consultations post-survey. Interviewed GPs/PNs were similarly positive about the toolbox and its added value.
Discussion/Conclusion: Preliminary results highlight the need for precision diabetes diagnosis support in primary care. Integrating the Atypical Diabetes toolbox into the existing clinical practice guidelines could address this need.