Use of expert consensus to improve the diagnosis and management of type 1 diabetes mellitus

Sep 29, 2026

Although type 1 diabetes mellitus (T1DM) is a catastrophic disease, it is frequently misdiagnosed and remains difficult to manage in routine care. The study aimed to form a multidisciplinary expert consensus and develop clinical recommendations to optimize diagnostic evaluation and transitional care. Evidence was reviewed and recommendations were rated through a two-round Delphi process with 32 specialists. Consensus was reached for two of six items, including preferences for glucagon testing and diabetic ketoacidosis history, and agreement on educator-led transitional care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

1. INTRODUCTION

Epidemiology and diagnostic challenges in Taiwan

Diabetes classification and differential considerations

2. METHODS

2.1. Study design (Delphi method)

2.2. Participants and questionnaire formation

J Chin MedAssoc Original article Use of expert consensus to improve the diagnosis and management of type 1 diabetes mellitus Chia-Hung Lina,b, Yi-Ching Tungc, Tien-Jyun Changd, Chien-Ning Huange,* , Chii-Min Hwuf,* for Taiwan Type 1 DM Consortium aDivision of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; bDepartment of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; cDepartment of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; dDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC; eDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; fSection of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Although type 1 diabetes mellitus (T1DM) is recognized as a catastrophic disease among the different types of diabetes, it is often confusedly diagnosed in clinical practice and difficult in care. The objective of this study is to reach a multidisciplinary consensus for the establishment of clinical recommendations on T1DM to optimize its undoubtedly diagnostic evaluation and transitional care. Methods: Scientific evidence was reviewed by a committee of researchers, based on which recommendations related to T1DM diagnosis were formulated. A two-round method was conducted to compare the opinions of a panel of 32 specialists (adult endocrinologists [53 . 1%], pediatric endocrinologists [43 .8%], a diabetes educator for child and adolescent [3 . 1%]) on these issues. Results: The panel reached consensus on two of the six items discussed. The four items on which no consensus was reached were related to autoantibody detection and age of onset. Up to 80% of the panelists favored items related to the glucagon test and diabetic ketoacidosis history for T1DM diagnosis. Consensus regarding transitional care through diabetes educators was established. Conclusion: The assessment conducted by experts on T1DM showed a high level of professional agreement regarding the proposed diagnostic and transitional care recommendations. A comprehensive analysis of the latest evidence is warranted for the items on which consensus was not established. Keywords: Consensus; Diagnosis; Type 1 diabetes 1. INTRODUCTION The number of new-onset type 1 diabetes mellitus (T1DM) cases in Taiwan is about 500 each year.1,2 Current incidence data reveal a trend towards an increasingly younger population with T1DM. The diagnosis of T1DM affects whether a patient qualifies for a partial waiver of self-paid medical expenses with *Address correspondence. Dr. Chien-Ning Huang and Dr. Chii-Min Hwu, Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: [cshy049@gmail.com](cshy049@gmail.com) (C.-N. Huang); [chhwu@vghtpe.gov.tw](chhwu@vghtpe.gov.tw) (C.-M. Hwu). A complete list of the members in Taiwan Type 1 DM Consortium is provided in the Appendix. Author contributions: Dr. Chia-Hung Lin and Dr. Yi-Ching Tung contributed equally to this work. Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 741-746. Received September 3, 2021; accepted October 31, 2021. doi: 10. 1097/JCMA.0000000000000751. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) catastrophic illness certificate in Taiwan; therefore,

FAQs

What was the primary objective of the study?

To reach a multidisciplinary consensus and establish clinical recommendations for diagnosing and managing type 1 diabetes mellitus (T1DM), including transitional care.

How were experts’ opinions collected and compared?

The committee reviewed scientific evidence and used a two-round Delphi process to compare the views of 32 specialists.

Which diagnostic and transitional care topics reached consensus?

Consensus was reached for two of six items; no consensus occurred for autoantibody detection and age of onset. Transitional care via diabetes educators achieved consensus.

Sep 29, 2026

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