Histological validation of a type 1 diabetes clinical diagnostic model for classification of diabetes.

AIMS: Misclassification of diabetes is common due to an overlap in the clinical features of type 1 and type 2 diabetes. Combined diagnostic models incorporating clinical and biomarker information have recently been developed that can aid classification, but they have not been validated using pancreatic pathology. We evaluated a clinical diagnostic model against histologically defined type 1 diabetes. METHODS: We classified cases from the Network for Pancreatic Organ donors with Diabetes (nPOD) biobank as type 1 (n = 111) or non-type 1 (n = 42) diabetes using histopathology. Type 1 diabetes was defined by lobular loss of insulin-containing islets along with multiple insulin-deficient islets. We assessed the discriminative performance of previously described type 1 diabetes diagnostic models, based on clinical features (age at diagnosis, BMI) and biomarker data [autoantibodies, type 1 diabetes genetic risk score (T1D-GRS)], and singular features for identifying type 1 diabetes by the area under the curve of the receiver operator characteristic (AUC-ROC). RESULTS: Diagnostic models validated well against histologically defined type 1 diabetes. The model combining clinical features, islet autoantibodies and T1D-GRS was strongly discriminative of type 1 diabetes, and performed better than clinical features alone (AUC-ROC 0.97 vs. 0.95; P = 0.03). Histological classification of type 1 diabetes was concordant with serum C-peptide [median < 17 pmol/l (limit of detection) vs. 1037 pmol/l in non-type 1 diabetes; P < 0.0001]. CONCLUSIONS: Our study provides robust histological evidence that a clinical diagnostic model, combining clinical features and biomarkers, could improve diabetes classification. Our study also provides reassurance that a C-peptide-based definition of type 1 diabetes is an appropriate surrogate outcome that can be used in large clinical studies where histological definition is impossible. Parts of this study were presented in abstract form at the Network for Pancreatic Organ Donors Conference, Florida, USA, 19-22 February 2019 and Diabetes UK Professional Conference, Liverpool, UK, 6-8 March 2019.

A survey of pet owner views of veterinarians in Brisbane environs - a behavioral approach.

Three hundred and thirty-seven pet owners were interviewed by final-year veterinary students from the University of Queensland, using a questionnaire prepared by the authors. The survey area included Brisbane city and suburbs and was conducted in 1977. The majority of respondents (52.5%) reported that the pets were owned by the family, while 24.6% claimed that pets were owned by individual adults only. Dogs and cats were the most popular pets. Of the respondents sampled, 51% changed their veterinarian while 46% reported that they had not changed their veterinarian. Satisfaction with the service, nearness of the service and personal liking were the major reasons for continuing to use the same veterinary surgeon. Nearly 40% of respondents used the veterinary service on the basis of recommendation of friends, relatives and other people who owned similar types of pets. According to the respondents, major qualities for a good veterinarian are: competence and knowledge (86.9%), compassion for animals (61.7%), professional approach (which includes good listening and explanation, the instillation of confidence, integrity and appearance) (57.4%), regard for owners and their feelings (46.3%), good surgery conditions (14.2%) and reasonable fees (12.8%). While professional competence was reported as one of the important qualities of a good veterinary service, the majority (51%) of them disagreed with the statement that professional competence is the only thing that matters in the care of pets and many other social and interpersonal factors influenced their attitude towards the veterinary service. The application of behavioural sciences to the veterinary profession is discussed.