{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:47:00Z","timestamp":1792028820516,"version":"4.4.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100013374","name":"NIHR School for Primary Care Research","doi-asserted-by":"publisher","award":["595"],"award-info":[{"award-number":["595"]}],"id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The correct classification of diabetes (type 1, type 2 or rarer genetic forms) is essential for optimal treatment, but misclassification is common. The Diabetes in Primary Care Improving Classification (DePICtion) tool uses routinely collected clinical data to flag patients at risk of misclassification and prioritise them for further diagnostic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the acceptability and implementation of the DePICtion tool in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting<\/jats:title>\n                    <jats:p>A qualitative study in 11 general practices across the Southwest and East Midlands, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Twelve practices were recruited to the study; 11 practices ran the tool and reviewed flagged patients. Semi\u2010structured interviews were conducted with 10 staff and 11 patients to explore their experiences of the tool, reactions to the results and barriers and facilitators to use. Data were analysed thematically in NVivo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Staff found the tool straightforward, compatible with existing workflows and clinically useful. Implementation required time and ownership of the process. Patients' responses were shaped by trust in staff and the personal meaning of their diabetes: Some viewed reclassification as a threat to their diagnostic identity, while others welcomed further diagnostic testing. Data privacy concerns were minimal but competing demands on staff time and resources were ubiquitously reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The DePICtion tool is acceptable and clinically useful for improving diabetes classification in primary care. Routine implementation is technically feasible but will require protected time, clear pathways for follow\u2010up and support for patient communication and engagement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70493","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:37:13Z","timestamp":1792028233000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The\n                    <scp>DePICtion<\/scp>\n                    study: Implementing a diabetes classification tool in\n                    <scp>UK<\/scp>\n                    primary care\u2014A qualitative study with primary care staff and patients"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8252-9538","authenticated-orcid":false,"given":"Charlotte","family":"Lee","sequence":"first","affiliation":[{"name":"University of Bristol Medical School  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddy","family":"Geen","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9121-1484","authenticated-orcid":false,"given":"Clare","family":"Timblin","sequence":"additional","affiliation":[{"name":"University of Nottingham School of Medicine  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Hill","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-3864","authenticated-orcid":false,"given":"Katherine","family":"Young","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Humphreys","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"Jones","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"},{"name":"Royal Devon University Healthcare NHS Foundation Trust  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2660-0955","authenticated-orcid":false,"given":"Maggie","family":"Shepherd","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"},{"name":"Royal Devon University Healthcare NHS Foundation Trust  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-473X","authenticated-orcid":false,"given":"Andrew T.","family":"Hattersley","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"},{"name":"Royal Devon University Healthcare NHS Foundation Trust  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem","family":"Qureshi","sequence":"additional","affiliation":[{"name":"University of Nottingham School of Medicine  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3785-327X","authenticated-orcid":false,"given":"Beverley M.","family":"Shields","sequence":"additional","affiliation":[{"name":"University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6375-2918","authenticated-orcid":false,"given":"Katrina","family":"Turner","sequence":"additional","affiliation":[{"name":"University of Bristol Medical School  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"Overview | Type 2 Diabetes in Adults: Management | Guidance | NICE [Internet]","year":"2015"},{"key":"e_1_2_14_3_1","volume-title":"Overview | Type 1 Diabetes in Adults: Diagnosis and Management | Guidance | NICE [Internet]","year":"2015"},{"issue":"4","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/cen.14744","article-title":"How do I diagnose maturity onset diabetes of the young in my patients?","volume":"97","author":"Colclough K","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"12","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1007\/s00125-023-06004-4","article-title":"The challenges of identifying and studying type 1 diabetes in adults","volume":"66","author":"Thomas NJ","year":"2023","journal-title":"Diabetologia"},{"issue":"3","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"642","DOI":"10.2337\/dc21-2056","article-title":"Improvements in awareness and testing have led to a threefold increase over 10\u2009years in the identification of monogenic diabetes in the U.K","volume":"45","author":"Pang L","year":"2022","journal-title":"Diabetes Care"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.1186\/s13098-020-00557-9","article-title":"Update on clinical screening of maturity\u2010onset diabetes of the young (MODY)","volume":"12","author":"Peixoto\u2010Barbosa R","year":"2020","journal-title":"Diabetol Metab Syndr"},{"issue":"5","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1007\/s00125-011-2418-8","article-title":"The development and validation of a clinical prediction model to determine the probability of MODY in patients with young\u2010onset diabetes","volume":"55","author":"Shields BM","year":"2012","journal-title":"Diabetologia"},{"key":"e_1_2_14_9_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-031586","article-title":"Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18\u201350\u2009years","volume":"9","author":"Lynam A","year":"2019","journal-title":"BMJ Open"},{"issue":"9","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: a synthesis of recommendations","volume":"89","author":"O'Brien BC","year":"2014","journal-title":"Acad Med"},{"issue":"6","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32\u2010item checklist for interviews and focus groups","volume":"19","author":"Tong A","year":"2007","journal-title":"International J Qual Health Care"},{"key":"e_1_2_14_12_1","unstructured":"NHS England.National genomic test directory [Internet]. [cited 2025 Dec 1]. Available from:https:\/\/www.england.nhs.uk\/publication\/national\u2010genomic\u2010test\u2010directories\/"},{"issue":"2","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.7861\/clinmedicine.4-2-144","article-title":"\u2018I don't feel like a diabetic any more\u2019: the impact of stopping insulin in patients with maturity onset diabetes of the young following genetic testing","volume":"4","author":"Shepherd M","year":"2004","journal-title":"Clin Med (Lond)"},{"issue":"720","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.3399\/BJGP.2021.0558","article-title":"Introducing genetic testing with case finding for familial hypercholesterolaemia in primary care: qualitative study of patient and health professional experience","volume":"72","author":"Silva L","year":"2022","journal-title":"Br J Gen Pract"},{"key":"e_1_2_14_15_1","unstructured":"Online SoECAT Guidance | NIHR [Internet]. [cited 2025 Oct 20]. Available from:https:\/\/www.nihr.ac.uk\/online\u2010soecat\u2010guidance"},{"key":"e_1_2_14_16_1","unstructured":"Payment guidance for researchers and professionals | NIHR [Internet]. [cited 2025 Oct 20]. Available from:https:\/\/www.nihr.ac.uk\/payment\u2010guidance\u2010researchers\u2010and\u2010professionals"},{"key":"e_1_2_14_17_1","doi-asserted-by":"crossref","DOI":"10.4135\/9781036232078.n9","volume-title":"Thematic Analysis: A Practical Guide","author":"Braun V","year":"2021"},{"issue":"3","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","article-title":"A worked example of Braun and Clarke's approach to reflexive thematic analysis","volume":"56","author":"Byrne D","year":"2022","journal-title":"Qual Quant"},{"issue":"1","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-8-63","article-title":"Normalisation process theory: a framework for developing, evaluating and implementing complex interventions","volume":"8","author":"Murray E","year":"2010","journal-title":"BMC Med"},{"key":"e_1_2_14_20_1","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles MB","year":"2020"},{"key":"e_1_2_14_21_1","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles MB","year":"2014"},{"key":"e_1_2_14_22_1","unstructured":"Lumivero.NVivo (Version 14) [Computer software].2023. Lumivero."},{"issue":"2","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1136\/ebnurs-2025-104292","article-title":"Alternatives to \u2018saturation\u2019 for greater transparency in reporting of sample size decision\u2010making in qualitative research","volume":"28","author":"Younas A","year":"2025","journal-title":"Evid Based Nurs"},{"issue":"1","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1370\/afm.2908","article-title":"Barriers and facilitators to the use of clinical decision support Systems in Primary Care: a mixed\u2010Methods systematic review","volume":"21","author":"Meunier PY","year":"2023","journal-title":"Ann Fam Med"},{"issue":"11","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003384","article-title":"\u2018I call it the blame and shame disease\u2019: a qualitative study about perceptions of social stigma surrounding type 2 diabetes","volume":"3","author":"Browne JL","year":"2013","journal-title":"BMJ Open"},{"issue":"1","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6823-13-25","article-title":"What's distressing about having type 1 diabetes? A qualitative study of young adults' perspectives","volume":"13","author":"Balfe M","year":"2013","journal-title":"BMC Endocr Disord"},{"issue":"7","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1111\/j.1464-5491.2010.03022.x","article-title":"Stopping insulin injections following genetic testing in diabetes: impact on identity","volume":"27","author":"Shepherd M","year":"2010","journal-title":"Diabet Med"},{"key":"e_1_2_14_28_1","doi-asserted-by":"crossref","unstructured":"Department of Health and Social Care.Fit for the future: 10 Year Health Plan for England.2025.https:\/\/www.gov.uk\/government\/publications\/10\u2010year\u2010health\u2010plan\u2010for\u2010england\u2010fit\u2010for\u2010the\u2010future","DOI":"10.12968\/jokc.2025.10.5.212"},{"key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s11606-022-07768-y","article-title":"Communication of diagnostic uncertainty in primary care and its impact on patient experience: an integrative systematic review","volume":"38","author":"Dahm MR","year":"2023","journal-title":"J Gen Intern Med"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70493","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70493","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70493","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:37:17Z","timestamp":1792028237000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":28,"alternative-id":["10.1111\/dme.70493"],"URL":"https:\/\/doi.org\/10.1111\/dme.70493","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"assertion":[{"value":"2026-04-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70493"}}