Distinguishing type 1 from type 2 diabetes

Evidence suggests that 7-15% of individuals with diabetes are misclassified, and so receive inappropriate treatment, yet evidence-based guidelines for diabetes classification do not exist. To help in the classification of type 1 and type 2 diabetes we undertook a systematic review of the performance of clinical features (see Shields et al). We are now conducting a systematic review of the performance of autoantibody testing close to diagnosis to help distinguish type 1 from type 2 diabetes. The protocol is registered with PROSPERO and can be found here. This work has been done with Prof Andrew Hattersley, Dr Bev Shields, Dr Kash Patel and other colleagues from the Institute of Biomedical & Clinical Science at the University of Exeter Medical School.

Contact: Jaime Peters, Zhivko Zhelev, Chris Hyde

Using pharmacogenetics testing to identify monogenic diabetes earlier (The UNITED project)

We are involved in the development and analysis of a decision-analytic model to evaluate and compare the lifetime costs associated with different strategies to identify individuals with monogenic diabetes. Monogenic diabetes usually presents in patients under the age of 30 years, and so is often misdiagnosed as type 1 diabetes leading to patients receiving more invasive and costly treatment than is necessary. Strategies to identify individuals with a high likelihood of having monogenic diabetes therefore have the potential to be cost-effective to the NHS. This Wellcome Trust and Department of Health funded work is with Prof Andrew Hattersley, Prof Sian Ellard and colleagues at the Institute of Biomedical & Clinical Science. Details of the development of the decision model have been published (Peters et al).

Contact: Jaime Peters, Chris Hyde

Stratifying treatment for type 2 diabetes (MASTERMIND project)

Stratified medicine is a major current theme in medical research and a particular interest in the University of Exeter Medical School. The MRC funded MASTERMIND project led by Prof Andrew Hattersley is exploring the potential for stratification of treatment in type 2 diabetes. In parallel with clinical studies and analysis of routine data to identify sub-groups who might have different responses to anti-diabetic medication, we are working with groups in Universities of Oxford and Bath to examine whether stratification is likely to be cost-effective. In particular we are exploring the criteria which need to be met in terms of size of sub-group and effect size in that sub-group for a stratification approach to be good value for money.

Contact: Chris Hyde