My interview with Dr. Irl Hirsch

Some of you know that I have a blog on adult-onset Type 1 diabetes, and I often write about the problem of misdiagnosis. I recently heard Dr. Irl Hirsch speak at the TCOYD ONE Conference in San Diego, and I asked him if I could interview him. We had a great discussion about the reasons for misdiagnosis! Here is my blog, interviewing Dr. Hirsch.

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Fascinating. And confirming. Thanks for posting this.

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Thanks for bringing this to our attention. Dr. Hirsch did list some daunting challenges doctors face when trying to correctly diagnose T1D. The 15-20 minute patient visit limit seems to be a major reason for this high misdiagnosis rate of T2Ds who are really T1Ds.

Great interview!

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Interestingly, misdiagnosis isn’t a rare thing in the medical world. It happens in every specialty, for instance cardiologists and neurologists misdiagnose people that faint every once in a while (syncope), where about 20% of each population of people who faint are seeing the wrong specialist, it is just hard to diagnose.

Finally, it has been shown that with a proper history and physical (which takes much much longer than 20 minutes) a physician can correctly diagnose more than 80% of patients without further testing. Of course, the amount reimbursed for a proper H&P would need to increase considerably if this were to happen on a regular basis, but that isn’t the way of the current healthcare world…

Good point about misdiagnosis not being unique to diabetes. It does indeed happen in every specialty. I have friends who have been misdiagnosed by cardiologists, neurologists, and pulmonologists.

I do agree that misdiagnosis is common for a variety of illnesses/diseases. But I do also believe that there are particularly egregious problems with the misdiagnosis of Type 1 as Type 2, just because a person is an adult. And it is a huge problem, in that ~10% of people diagnosed with “Type 2” diabetes are actually misdiagnosed Type 1s–an enormous number in the millions of people. The myth that Type 1 diabetes is a childhood disease persists, and no diabetes entity is making any effort to change that situation. Type 1 and Type 2 are altogether different diseases, but the diabetes governing bodies have no requirement that a medical doctor distinguish between the two. In the United States, a medical doctor faces no repercussions if he/she misdiagnoses a person as having Type 2 diabetes when in reality the person has adult-onset Type 1 diabetes. The governing bodies (the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus; the American Association of Clinical Endocrinologists) describe the different diseases that fall under the umbrella term “diabetes,” but they do not identify any protocols for differentiating amongst the different diseases, despite the fact that autoantibody testing can distinguish autoimmune diabetes from non-autoimmune diabetes. So there is no requirement to diagnose, classify, and appropriately treat the different diseases that fall under the term “diabetes.” If there were a standard or guideline, doctors would be held accountable to the minimum standard of care: anything less would be malpractice. I don’t know of another disease where being diagnosed with an altogether different disease (Type 2) is acceptable, and where so many millions are impacted.


All of that is true and I can’t take issue with any part of it. My only point is that misdiagnosis can lead to years of avoidable misery or unnecessary death in any specialty. And does.

If there’s a worthwhile lesson to be drawn here, it’s the same one we tell people continually: you must be your own expert and strongest advocate. No one else will do it for you.