Practical classification guidelines for diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis
Open accessAbstract
BACKGROUND: Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation. AIM: To assess diagnostic accuracy of the UK guidelines against 'gold standard' definitions of type 1 and type 2 diabetes based on measured C-peptide levels. DESIGN AND SETTING: In total, 601 adults with insulin-treated diabetes and diabetes duration ≥5 years were recruited in Devon, Northamptonshire, and Leicestershire. METHOD: Baseline information and home urine sample were collected. Urinary C-peptide creatinine ratio (UCPCR) measures endogenous insulin production. Gold standard type 1 diabetes was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR<0.2 nmol/mmol ≥5 years post-diagnosis); all others classed as having type 2 diabetes. Diagnostic performance of the clinical criteria was assessed and other criteria explored using receiver operating characteristic (ROC) curves. RESULTS: UK guidelines correctly classified 86% of participants. Most misclassifications occurred in patients classed as having type 1 diabetes who had significant endogenous insulin levels (57 out of 601; 9%); most in those diagnosed ≥35 years and treated with insulin from diagnosis, where 37 out of 66 (56%) were misclassified. Time to insulin and age at diagnosis performed best in predicting long-term endogenous insulin production (ROC AUC = 0.904 and 0.871); BMI was a less strong predictor of diabetes type (AUC = 0.824). CONCLUSION: Current UK guidelines provide a pragmatic clinical approach to classification reflecting long-term endogenous insulin production; caution is needed in older patients commencing insulin from diagnosis, where misclassification rates are increased.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Adults with type 1 diabetes may retain sufficient β-cell function to prevent DKA for many years; such individuals may have remission or decreased insulin needs for months or years, eventually become dependent on insulin for survival, and are at risk for DKA.
“Adults may retain suf fi cient b -cell function to prevent DKA for many years; such individuals may have remission or decreased insulin needs for months or years, eventually become dependent on insulin for survival, and are at risk for DKA (33 -35,60,61).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [35]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe onset of type 1 diabetes may be more variable in adults; they may not present with the classic symptoms seen in children and may experience temporary remission from the need for anticipated full-dose insulin replacement.
“The onset of type 1 diabetes may be more variable in adults; they may not present with the classic symptoms seen in children and may experience temporary remission from the need for anticipated full-dose insulin replacement (33 -35).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [35]
The Discussion (Implications for research and practice; page unavailable) describes adults with latent autoimmune diabetes who may not need insulin for at least six months, supporting a variable course of insulin need. It does not discuss whether adults lack the classic symptoms seen in children or experience a temporary remission after needing full-dose insulin replacement. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdults may retain sufficient b-cell function to prevent DKA for many years; such individuals may have remission characterized by decreased insulin needs for months or years, eventually become dependent on insulin for survival, and are at risk for DKA.
“Adults may retain sufficient b-cell function to prevent DKA for many years; such individuals may have remission characterized by decreased insulin needs for months or years, eventually become dependent on insulin for survival, and are at risk for DKA (33-35, 59,60).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [35]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredRapid progression to insulin treatment (<3 years) is strongly suggestive of type 1 diabetes at any age.
“Rapid progression to insulin treatment (<3 years) is strongly suggestive of type 1 diabetes at any age (6,8,15).”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [8]
The Results (Optimal clinical criteria; page not available) identify time from diagnosis to insulin as the strongest individual discriminator, supporting the link between rapid insulin treatment and type 1 diabetes. But the optimal cut-off was 12 months, not three years. The Discussion (Implications for research and practice; page not available) also reports substantial misclassification among people diagnosed at age 35 or older and treated with insulin from diagnosis, so the unqualified claim that this is strongly suggestive at any age is not supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredApproximately 5-10% of White European people with new-onset type 1 diabetes have negative islet antibodies.
“The absence of autoantibodies does not exclude type 1 diabetes, since approximately 5-10% of White European people with new-onset type 1 diabetes have negative islet antibodies (8,9,25), and further consideration of the diagnosis is necessary.”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [8]
The Results describe white European patients who had diabetes for at least five years, not people with new-onset diabetes. The Discussion (Implications for research and practice) proposes studies using islet antibodies at diagnosis, but gives no estimate of how often people with new-onset type 1 diabetes test negative. Searches for antibody-negative cases and the 5–10% figure found no supporting passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
The absence of autoantibodies does not exclude type 1 diabetes.
“The absence of autoantibodies does not exclude type 1 diabetes, since approximately 5-10% of White European people with new-onset type 1 diabetes have negative islet antibodies (8,9,25), and further consideration of the diagnosis is necessary.”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [8]
The Introduction and Abstract Method define type 1 diabetes using insulin deficiency and treatment history, but do not report whether patients lacked autoantibodies. The Discussion (Implications for research and practice; page unavailable) proposes studying islet antibodies to improve diagnosis, without saying whether a negative result excludes type 1 diabetes. Searches for antibody-negative type 1 diabetes and antibody-test sensitivity found no passage addressing the claim. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnosis and Classification of Diabetes Mellitus
Basevi, V. (2011) · Diabetes Care · doi:10.2337/dc11-s062 · Cited by 21,302 · see citing works
Pencina, M. J., D' Agostino, R. B., D' Agostino, R. B., & Vasan, R. S. (2008) · Statistics in Medicine · doi:10.1002/sim.2929 · Cited by 6,493 · see citing works
Standards of medical care in diabetes—2013
American Diabetes Association (2013) · Diabetes Care · doi:10.2337/dc13-s011 · Cited by 4,369 · see citing works
Finucane, M. M., Stevens, G. A., Cowan, M. J., Danaei, G., Lin, J. K., Paciorek, C. J., Singh, G. M., Gutierrez, H. R., Lu, Y., Bahalim, A. N., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62037-5 · Cited by 4,050 · see citing works
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., & Matthews, D. R. (2012) · Diabetologia · doi:10.1007/s00125-012-2534-0 · Cited by 3,919 · see citing works
Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., & Matthews, D. R. (2012) · Diabetes Care · doi:10.2337/dc12-0413 · Cited by 3,207 · see citing works
Cross sectional stature and weight reference curves for the UK, 1990.
Freeman, J. V., Cole, T. J., Chinn, S., Jones, P. R., White, E. M., & Preece, M. A. (1995) · Archives of Disease in Childhood · doi:10.1136/adc.73.1.17 · Cited by 1,460 · see citing works
The Royal College of General Practitioners
Fry, J. (1983) · Springer eBooks · doi:10.1007/978-94-011-7304-9_14 · Cited by 1,317 · see citing works
Diagnosis and Classification of Diabetes Mellitus
American Diabetes Association (2008) · Diabetes Care · doi:10.2337/dc08-s055 · Cited by 1,062 · see citing works
Tuomi, T., Groop, L., Zimmet, P., Rowley, M. J., Knowles, W. J., & Mackay, I. R. (1993) · Diabetes · doi:10.2337/diab.42.2.359 · Cited by 581 · see citing works
College of General Practitioners
Abercrombie, G. F., Hughes, H. L. G., & Hunt, J. H. (1954) · BMJ · doi:10.1136/bmj.1.4857.336-c · Cited by 505 · see citing works
Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus: Scientific Review
DeWitt, D. E., & Hirsch, I. B. (2003) · JAMA · doi:10.1001/jama.289.17.2254 · Cited by 502 · see citing works
Palmer, J. P., Fleming, G. A., Greenbaum, C. J., Herold, K. C., Jansa, L. D., Kolb, H., Lachin, J. M., Polonsky, K. S., Pozzilli, P., Skyler, J. S., et al. (2004) · Diabetes · doi:10.2337/diabetes.53.1.250 · Cited by 491 · see citing works
Best practice guidelines for the molecular genetic diagnosis of maturity-onset diabetes of the young
Ellard, S., Bellanné‐Chantelot, C., Hattersley, A. T., & European Molecular Genetics Quality Network (EMQN) MODY group (2008) · Diabetologia · doi:10.1007/s00125-008-0942-y · Cited by 434 · see citing works
Self-citationZimmet, P., Tuomi, T., Mackay, I. R., Rowley, M. J., Knowles, W., Cohen, M., & Lang, D. A. (1994) · Diabetic Medicine · doi:10.1111/j.1464-5491.1994.tb00275.x · Cited by 413 · see citing works
Combination therapies with insulin in type 2 diabetes
Yki-Järvinen, H. (2001) · Diabetes Care · doi:10.2337/diacare.24.4.758 · Cited by 300 · see citing works
Islet Cell Antibodies Identify Latent Type I Diabetes in Patients Aged 35–75 Years at Diagnosis
Groop, L., Bottazzo, G. F., & Doniach, D. (1986) · Diabetes · doi:10.2337/diab.35.2.237 · Cited by 292 · see citing works
Latent Autoimmune Diabetes in Adults
Stenström, G., Gottsäter, A., Bakhtadze, E., Berger, B., & Sundkvist, G. (2005) · Diabetes · doi:10.2337/diabetes.54.suppl_2.s68 · Cited by 213 · see citing works
Shields, B. M., Peters, J. L., Cooper, C., Lowe, J., Knight, B. A., Powell, R. J., Jones, A., Hyde, C. J., & Hattersley, A. T. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009088 · Cited by 126 · see citing works
Self-citationDe Lusignan, S., Khunti, K., Belsey, J., Hattersley, A., Van Vlymen, J., Gallagher, H., Millett, C., Hague, N. J., Tomson, C., Harris, K., et al. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2009.02917.x · Cited by 122 · see citing works
Self-citationAccuracy of Administrative Coding for Type 2 Diabetes in Children, Adolescents, and Young Adults
Rhodes, E. T., Laffel, L. M., Gonzalez, T. V., & Ludwig, D. S. (2006) · Diabetes Care · doi:10.2337/dc06-1142 · Cited by 103 · see citing works
Random C-peptide in the classification of diabetes
B. Berger, G. S. (2000) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365510050216411 · Cited by 85 · see citing works
Besser, R. E. J., Ludvigsson, J., Jones, A. G., McDonald, T. J., Shields, B. M., Knight, B. A., & Hattersley, A. T. (2011) · Diabetes Care · doi:10.2337/dc10-2114 · Cited by 82 · see citing works
Self-citationIncorrect and incomplete coding and classification of diabetes: a systematic review
Stone, M. A., Camosso‐Stefinovic, J., Wilkinson, J., de Lusignan, S., Hattersley, A. T., & Khunti, K. K. (2009) · Diabetic Medicine · doi:10.1111/j.1464-5491.2009.02920.x · Cited by 78 · see citing works
Self-citationMcDonald, T. J., Knight, B. A., Shields, B. M., Bowman, P., Salzmann, M. B., & Hattersley, A. T. (2009) · Clinical Chemistry · doi:10.1373/clinchem.2009.129312 · Cited by 75 · see citing works
Self-citationService, F. J., Rizza, R. A., Zimmerman, B. R., Dyck, P. J. B., O’Brien, P. C., & Melton, L. J. (1997) · Diabetes Care · doi:10.2337/diacare.20.2.198 · Cited by 73 · see citing works
Khunti, K. K., Kumar, S., & Brodie, J. (2009) · Cited by 66 · see citing works
Self-citationLipton, R., Ghannam, J. H., & Beinin, J. (2003) · JAMA · doi:10.1001/jama.290.17.2254-a · Cited by 51 · see citing works
Diagnosis, classification, and treatment of diabetes
Farmer, A. A., & Fox, R. A. (2011) · BMJ · doi:10.1136/bmj.d3319 · Cited by 42 · see citing works
Bowman, P., McDonald, T. J., Shields, B. M., Knight, B. A., & Hattersley, A. T. (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03428.x · Cited by 40 · see citing works
Self-citationJones, A. G., Besser, R. E. J., McDonald, T. J., Shields, B. M., Hope, S. V., Bowman, P., Oram, R. A., Knight, B., & Hattersley, A. T. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03272.x · Cited by 39 · see citing works
Self-citationInfluence of exogenous insulin on C-peptide levels in subjects with type 2 diabetes
Albareda, M., Rigla, M., Rodrı́guez-Espinosa, J., Caballero, A., Chico, A. I., Cabezas, R., Carreras, G., & Pérez, A. (2004) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2004.10.005 · Cited by 31 · see citing works
Lindström, T., Arnqvist, H. J., Ludvigsson, J., & von Schenck, H. (1992) · European Journal of Endocrinology · doi:10.1530/acta.0.1260477 · Cited by 24 · see citing works
The impact of insulin administration during the mixed meal tolerance test
Besser, R. E. J., Jones, A. G., McDonald, T. J., Shields, B. M., Knight, B., & Hattersley, A. T. (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03649.x · Cited by 21 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [29]National Institute for Health and Care Excellence Type 1 diabetes in adults: diagnosis and management NICE guidelines [NG17] 2015 https://www.nice.org.uk/guidance/ng17 (accessed 14 Mar 2016). 26334079
Cited by
Sorted by citations
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s002 · Cited by 4,792 · see citing works
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2020</i>
American Diabetes Association (2020) · Diabetes Care · doi:10.2337/dc20-s002 · Cited by 3,187 · see citing works
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s002 · Cited by 3,116 · see citing works
2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Gaglia, J. L., Hilliard, M. E., Isaacs, D. M., et al. (2022) · Diabetes Care · doi:10.2337/dc23-s002 · Cited by 2,646 · see citing works
Self-citation2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s002 · Cited by 2,086 · see citing works
Self-citationDiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31320-5 · Cited by 1,561 · see citing works
Self-citation2. Diagnosis and classification of diabetes: standards of care in diabetes-2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Ebekozien, O., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s002 · Cited by 1,393 · see citing works
Self-citationHolt, R. I. G., DeVries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., et al. (2021) · Diabetes Care · doi:10.2337/dci21-0043 · Cited by 699 · see citing works
2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s002 · Cited by 473 · see citing works
Thomas, N. J., Jones, S. E., Weedon, M. N., Shields, B. M., Oram, R. A., & Hattersley, A. T. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30362-5 · Cited by 417 · see citing works
Self-citationHolt, R., DeVries, J., Hess-Fischl, A., Hirsch, I., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., et al. (2021) · Diabetologia · doi:10.1007/s00125-021-05568-3 · Cited by 1,374 · see citing works
Sharp, S. A., Rich, S. S., Wood, A. R., Jones, S. E., Beaumont, R. N., Harrison, J. W., Schneider, D. A., Locke, J. M., Tyrrell, J., Weedon, M. N., et al. (2019) · Diabetes Care · doi:10.2337/dc18-1785 · Cited by 366 · see citing works
Self-citationThe Incidence of Adult-Onset Type 1 Diabetes: A Systematic Review From 32 Countries and Regions
Harding, J. L., Wander, P. L., Zhang, X., Li, X., Karuranga, S., Chen, H., Sun, H., Xie, Y., Oram, R. A., Magliano, D. J., et al. (2022) · Diabetes Care · doi:10.2337/dc21-1752 · Cited by 145 · see citing works
Self-citationUse of human islets to understand islet biology and diabetes: progress, challenges and suggestions
Hart, N. J., & Powers, A. C. (2018) · Diabetologia · doi:10.1007/s00125-018-4772-2 · Cited by 141 · see citing works
Systematic Review of Polygenic Risk Scores for Type 1 and Type 2 Diabetes
Padilla-Martínez, F., Collin, F., Kwaśniewski, M., & Kretowski, A. J. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21051703 · Cited by 86 · see citing works
Lynam, A., McDonald, T., Hill, A., Dennis, J., Oram, R., Pearson, E., Weedon, M., Hattersley, A., Owen, K., Shields, B., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-031586 · Cited by 72 · see citing works
Self-citationGenetics of Monogenic Diabetes: Present Clinical Challenges
Misra, S., & Owen, K. R. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1111-4 · Cited by 72 · see citing works
Recent Updates to Clinical Practice Guidelines for Diabetes Mellitus
Yu, J. S., Lee, S.-H., & Kim, M. K. (2022) · Endocrinology and Metabolism · doi:10.3803/enm.2022.105 · Cited by 70 · see citing works
Foteinopoulou, E., Clarke, C. A. L., Pattenden, R. J., Ritchie, S. A., McMurray, E. M., Reynolds, R. M., Arunagirinathan, G., Gibb, F. W., McKnight, J. A., & Strachan, M. W. J. (2021) · Diabetic Medicine · doi:10.1111/dme.14449 · Cited by 61 · see citing works
The phenotype of type 1 diabetes in sub-Saharan Africa
Katte, J.-C. N., McDonald, T. J., Sobngwi, E., & Jones, A. G. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1014626 · Cited by 43 · see citing works
Self-citationHope, S. V., Taylor, P. J., Shields, B. M., Hattersley, A. T., & Hamilton, W. T. (2017) · Primary care diabetes · doi:10.1016/j.pcd.2017.08.004 · Cited by 42 · see citing works
Self-citationHope, S. V., Knight, B., Shields, B. M., Hill, A. V., Choudhary, P., Strain, W. D., McDonald, T. J., & Jones, A. G. (2017) · Diabetologia · doi:10.1007/s00125-017-4449-2 · Cited by 43 · see citing works
Self-citationClinical and research uses of genetic risk scores in type 1 diabetes
Sharp, S. A., Weedon, M. N., Hagopian, W., & Oram, R. A. (2018) · Current Opinion in Genetics & Development · doi:10.1016/j.gde.2018.03.009 · Cited by 40 · see citing works
Self-citationMata‐Cases, M., Mauricio, D., Real, J., Bolíbar, B., & Franch‐Nadal, J. (2016) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2016.07.004 · Cited by 36 · see citing works
Leichter, S. B., Felton, J. L., Rasmussen, C. G., Rizzuto, P., Bellini, N. J., Ebekozien, O. A., & Schulman‐Rosenbaum, R. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf194 · Cited by 30 · see citing works
Thomas, N. J. M., McGovern, A. P., Young, K., Sharp, S. A., Weedon, M. N., Hattersley, A. T., Dennis, J., & Jones, A. G. (2022) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2022.10.022 · Cited by 29 · see citing works
Self-citationFuture Roadmaps for Precision Medicine Applied to Diabetes: Rising to the Challenge of Heterogeneity
Bowman, P., Flanagan, S. E., & Hattersley, A. T. (2018) · Journal of Diabetes Research · doi:10.1155/2018/3061620 · Cited by 25 · see citing works
Self-citationEason, R. J., Thomas, N. J. M., Hill, A. V., Knight, B., Carr, A. L. J., Hattersley, A. T., McDonald, T. J., Shields, B. M., Jones, A. G., for the StartRight Study Group, et al. (2022) · Diabetes Care · doi:10.2337/dc22-0623 · Cited by 24 · see citing works
Self-citationShityakov, S., Nagai, M., Ergün, S., Braunger, B. M., & Förster, C. Y. (2022) · Biomolecules · doi:10.3390/biom12081113 · Cited by 22 · see citing works
Non-coding RNAs in diabetes mellitus and diabetic cardiovascular disease
Li, C., Wang, D., Jiang, Z., Gao, Y., Sun, L., Li, R., Chen, M., Lin, C., & Liu, D. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.961802 · Cited by 20 · see citing works
Developing services to support the delivery of care to people with early‐onset type 2 diabetes
Misra, S., Gable, D. R., Khunti, K. K., Barron, E., Young, B., Kar, P. S., & Valabhji, J. (2022) · Diabetic Medicine · doi:10.1111/dme.14927 · Cited by 20 · see citing works
Self-citationWang, X., Guo, B., Yang, X., Li, J., Baima, Y., Yin, J., Yu, J., Xu, H. Y., Zeng, C., Feng, S., et al. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac438 · Cited by 18 · see citing works
Thomas, N. J. M., Hill, A. V., Dayan, C. M., Oram, R. A., McDonald, T. J., Shields, B. M., Jones, A. G., StartRight Study Group, Simon, G., Ramos, A., et al. (2023) · Diabetes Care · doi:10.2337/dc22-2159 · Cited by 18 · see citing works
Self-citationMayega, R. W., & Rutebemberwa, E. (2018) · African Health Sciences · doi:10.4314/ahs.v18i3.29 · Cited by 17 · see citing works
Thal, S. C., Shityakov, S., Salvador, E., & Förster, C. Y. (2025) · Biomolecules · doi:10.3390/biom15040499 · Cited by 15 · see citing works
Exploring the potential role of C‐peptide in type 2 diabetes management
Lin, Y., McCrimmon, R. J., & Pearson, E. R. (2025) · Diabetic Medicine · doi:10.1111/dme.15469 · Cited by 16 · see citing works
Does myopia decrease the risk of diabetic retinopathy in both type-1 and type-2 diabetes mellitus?
Thakur*, S., Verkicharla, P. K., Kammari, P., & Rani, P. K. (2021) · Indian Journal of Ophthalmology · doi:10.4103/ijo.ijo_1403_21 · Cited by 12 · see citing works
Evaluation of polygenic risk scores to differentiate between type 1 and type 2 diabetes
Shoaib, M., Ye, Q., IglayReger, H. B., Tan, M. H., Boehnke, M., Burant, C., Soleimanpour, S. A., & Taliun, S. A. G. (2023) · Genetic Epidemiology · doi:10.1002/gepi.22521 · Cited by 10 · see citing works
Hu, J., Jiang, G., Qin, J., Luo, S., Fan, B., Xie, Z., Wan, R., Li, X., Tam, C. H. T., Wang, Z., et al. (2025) · Diabetologia · doi:10.1007/s00125-025-06455-x · Cited by 10 · see citing works
Self-citationMALDI-TOF mass spectrometry-based quantification of C-peptide in diabetes patients
Wan, M., Wang, Y., Zhan, L., Fan, J., & Hu, Y. (2019) · European Journal of Mass Spectrometry · doi:10.1177/1469066719865265 · Cited by 10 · see citing works
Replacing insulin with immunotherapy: Time for a paradigm change in Type 1 diabetes
Tatović, D., & Dayan, C. M. (2021) · Diabetic Medicine · doi:10.1111/dme.14696 · Cited by 10 · see citing works
Xu, M., Ge, Z., Huang, J., Shao, X., Li, J., MRCP, & Yang, J. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13919 · Cited by 9 · see citing works
Hjelm, L. (2022) · Clinics in Podiatric Medicine and Surgery · doi:10.1016/j.cpm.2022.05.001 · Cited by 8 · see citing works
Yi, Y., Guo, C., Zheng, Y., Chen, S., Lin, C., Lau, A. K. H., Wong, M. C. S., & Bishai, D. M. (2024) · Diabetes Care · doi:10.2337/dc24-1041 · Cited by 8 · see citing works
The challenge of diagnosing type 1 diabetes in older adults
Jones, A. G., Shields, B. M., Dennis, J., Hattersley, A. T., McDonald, T. J., & Thomas, N. J. M. (2020) · Diabetic Medicine · doi:10.1111/dme.14272 · Cited by 8 · see citing works
Self-citationReclassification of type 2 diabetes to type 1 diabetes in Asturias (Spain) between 2011 and 2020
Escobedo, R. R., Lambert, C., Morales-Sánchez, P., Delgado, E., & Torre, E. L. M. (2023) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-023-01069-y · Cited by 7 · see citing works
Thomas, N. J. M., Walkey, H. C., Kaur, A., Misra, S., Oliver, N. S., Colclough, K., Weedon, M. N., Johnston, D. G., Hattersley, A. T., & Patel, K. A. (2021) · medRxiv · doi:10.1101/2021.03.22.21252507 · Cited by 7 · see citing works
Self-citationLau, D. C. W., Shaw, E., Farris, M. S., McMullen, S., Brar, S., Cowling, T., Chatterjee, S., Quansah, K., Kyaw, M. H., & Girard, L. (2023) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2023.12.004 · Cited by 6 · see citing works
Pappachan, J. M., Sunil, B., Fernandez, C. J., Lahart, I. M., & Ashraf, A. P. (2022) · touchREVIEWS in Endocrinology · doi:10.17925/ee.2022.18.1.2 · Cited by 6 · see citing works
GADA persistence and diabetes classification
ten Kate, Q., Aanstoot, H., Birnie, E., Veeze, H. J., & Mul, D. (2016) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30103-6 · Cited by 6 · see citing works
Al‐Mulla, F., Alhomaidah, D. S., Abu‐Farha, M., Hasan, A., Al‐Khairi, I., Nizam, R., Alqabandi, R., Alkandari, H., & Abubaker, J. A. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1273476 · Cited by 5 · see citing works
Andersen, J. S., Stoltenberg, C. W., Jensen, M. H., Vestergaard, P., Hejlesen, O. K., & Hangaard, S. (2023) · Diabetes Epidemiology and Management · doi:10.1016/j.deman.2023.100190 · Cited by 5 · see citing works
Venkatesan, U., Amutha, A., Jones, A. G., Shields, B. M., Anjana, R. M., Ranjit Unnikrishnan, I., Mappillairaju, B., & Mohan, V. (2024) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2024.103007 · Cited by 5 · see citing works
Self-citationClinical features of childhood diabetes mellitus focusing on latent autoimmune diabetes
Lee, S. H., & Yu, J. (2016) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2016.21.4.212 · Cited by 5 · see citing works
β-Cell mass versus function in type 1 diabetes mellitus: truth or dare?
Calvo, T. R., Atkinson, M. A., & von Herrath, M. (2017) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2017.83 · Cited by 5 · see citing works
Mata‐Cases, M., Mauricio, D., Real, J., Bolíbar, B., & Franch‐Nadal, J. (2016) · Endocrinología y Nutrición (English Edition) · doi:10.1016/j.endoen.2016.10.005 · Cited by 4 · see citing works
Predictive Modeling for Diabetes Subtype Classification in India: A Machine Learning Approach
Venkatesan, U., Amutha, A., Anjana, R. M., Ranjit Unnikrishnan, I., Mappillairaju, B., & Mohan, V. (2025) · Journal of Diabetology · doi:10.4103/jod.jod_233_24 · Cited by 4 · see citing works
Liu, T., Alagu Sankareswaran, S., Paterson, G. G., Akhtar, S., Angel, A., Asgar, O., Ashraf, S., Bidi, S., Breen, G. D., Broster, J., et al. (2025) · Scientific Reports · doi:10.1038/s41598-024-80348-8 · Cited by 4 · see citing works
Self-citationVolpe, S., Tortorella, C., Solfrizzi, V., & Piazzolla, G. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s321340 · Cited by 4 · see citing works
Alshamsi, F. E., Pathan, A., Yasin, J., Sharma, C., Alshemsi, H. A., Alblooshi, A., AlAwadhi, M. A., Alali, A. A., Alkuwaiti, M., Afandi, B. O., et al. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1687920 · Cited by 3 · see citing works
Rydosz, A. M. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-99887-1.00001-7 · Cited by 3 · see citing works
Dattani, R., Haq, Z. U., Shah, M., Kamalati, T., Pierce, B. F., Lucas, A. N., Baruwa, A., Bickford-Smith, L., Chilcott, J., Griffiths, T., et al. (2024) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2023-003873 · Cited by 2 · see citing works
Slater, T., Hernández, G., Drebert, Z. J., Henson, J. J., Goldney, J., Zaccardi, F., Sargeant, J. A., Brown, K., Webb, D. R., Papamargaritis, D., et al. (2025) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2025.109210 · Cited by 2 · see citing works
Self-citationGerush, K., Pashkovska, N. V., & Ukrainets, O. Z. (2024) · INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) · doi:10.22141/2224-0721.20.4.2024.1410 · Cited by 2 · see citing works
Leng, O., & Madathil, A. (2018) · AACE Clinical Case Reports · doi:10.4158/accr-2018-0091 · Cited by 2 · see citing works
Simultaneous Pancreas and Kidney Transplantation in Patients With Type 2 Diabetes Mellitus
Owen, R. V., Reynard, J., Thompson, E., Kourounis, G., Snowden, C. P., Maillo-Nieto, A., Shaw, J., Wilson, C. H., & White, S. A. (2025) · Transplant International · doi:10.3389/ti.2025.14772 · Cited by 1 · see citing works
Bruns, F., Fender, A. C., Poppenborg, T., Dudley, S. C., & Dobrev, D. (2025) · Cardiovascular Research · doi:10.1093/cvr/cvaf252 · Cited by 1 · see citing works
Astavans, A., Baughman, D. J., & Mathioudakis, N. N. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwag360 · Cited by 1 · see citing works
Metabolic Disorders and Management of High-Risk Patients
Edmonds, M. E. (2020) · Elsevier eBooks · doi:10.1016/b978-0-7020-6223-0.00010-8 · Cited by 1 · see citing works
Antiplatelet and Antithrombotic Therapy in Type I Diabetes Mellitus: Update on Current Data
Maragkoudakis, S., Katsi, V. K., Melidonis, A. J., Σουλαϊδόπουλος, Σ., Kolovou, G. D., Papazafeiropoulou, A., Trikkalinou, A., Toutouzas, K. P., & Tsioufis, K. P. (2022) · Current Diabetes Reviews · doi:10.2174/1573399818666220103091236 · Cited by 1 · see citing works
Hayward, R. C., Watkins, J., & Ariti, C. A. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3694479
Thomas, N. J. M., McGovern, A. P., Young, K., Sharp, S. A., Weedon, M. N., Hattersley, A. T., Dennis, J., & Jones, A. G. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4125231
Self-citationZinc transporter 8 antibody-mediated type 1 diabetes mellitus
Thornton, L. (2022) · The Nurse Practitioner · doi:10.1097/01.npr.0000841960.41027.65
Fang, M., McCoy, R. G., O’Connor, P. J., & Selvin, E. (2023) · American Public Health Association eBooks · doi:10.2105/9780875533377ch12
Erstdiagnose eines Typ-1-Diabetes im hohen Alter
Müssig, K., & Harms, M. (2024) · Info Diabetologie · doi:10.1007/s15034-024-4939-5
Suleman, Y. J. A., Alhassani, M. Y., & Hammoud, T. (2024) · Research Square · doi:10.21203/rs.3.rs-4717324/v1
Gul, S., Naseem, M., Sheikh, I. S., Ali, H. M., Rabbani, I., Jamil, T., Gul, S., Chachar, Z., Ullah, S., Asif, S., et al. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1687575
Ghani, M. R. A., Mohamed, Y. A., Elbialy, A., & Mohsen, I. (2026) · The Egyptian Journal of Internal Medicine · doi:10.1186/s43162-026-00593-3
The prevalence of autoimmune diseases in antibody negative type 1 diabetes mellitus
Bakjaji, S., Lahoti, A., Hoffman, R. P., & Mamilly, L. (2026) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2025-0705
Prediction of maturity-onset diabetes of the young subtypes using machine learning
Figueroa, I., Flores, R., Millán, A. L., Dios, A. D., Frechtel, G. D., López, A. P., & Mennickent, D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1656161
Mwakyula, I. H., Mbwile, G. R., & Nassoro, D. D. (2026) · Clinical Case Reports · doi:10.1002/ccr3.72430
Knupp, J., Hill, A., Thomas, N. J. M., McDonald, T. J., Young, K. G., Fraser, D. P., Hattersley, A. T., McKinley, T. J., Shields, B. M., & Jones, A. G. (2026) · medRxiv · doi:10.64898/2026.05.01.26352217
Self-citationEuglycemic Diabetic Ketoacidosis Triggered by SGLT2 Inhibitor Use in Undiagnosed Type 1 Diabetes
Eyalsalman, M. M., & El-Kaissi, S. (2026) · Journal of Diabetes and Endocrine Practice · doi:10.1055/s-0046-1820086
Wright, E. E., Wang, C. C. L., Novak, L. M., & Shubrook, J. H. (2026) · Postgraduate Medicine · doi:10.1080/00325481.2026.2672192
Holt, R. I. G., DeVries, J. H., Fischl, A. H., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, É., et al. (2026) · Diabetologia · doi:10.1007/s00125-026-06833-z
Shields, B. M., Young, K., Geen, M., Hill, A., Lee, C., Humphreys, R., Timblin, C., Colclough, K., Campbell, J., Hamilton, W., et al. (2026) · medRxiv · doi:10.64898/2026.10.20.26366000
Self-citation
- Authors
- Hope, S. V., Wienand-Barnett, S., Shepherd, M., King, S. M., Fox, C., Khunti, K., Oram, R. A., Knight, B. A., Hattersley, A. T., Jones, A. G., & Shields, B. M.
- Affiliations
- National Institute of Health Researches of Iran (IR)
- Northampton General Hospital (GB)
- University of Leicester (GB)
- University of Exeter (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2016-04-14
- Volume
- 66
- Issue
- 646
- Pages
- e315-e322
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC4838443
- OpenAlex
- W2336113197
- Cited by
- 87
- References
- 34
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 7 · 2023: 10 · 2022: 15 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 7 · 2017: 4 · 2016: 4
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- British Journal of General Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Open Research Exeter (University of Exeter) (submittedVersion, other-oa)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (CL-2015-23-001, ACF-2009-23-001, CL-2014-23-001, PB-PG-0711-25111, NF-SI-0611-10219, CS-2015-15-018)
- NIHR Exeter Clinical Research Facility
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, type 2 diabetes, diabetes classification, insulin-treated diabetes, endogenous insulin production, diagnostic accuracy, age at diagnosis, body mass index, misclassification
- MeSH terms
- C-Peptide, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Insulin, Male, ROC Curve, Reproducibility of Results, Biomarkers, Body Mass Index, Practice Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
