Abstract
BackgroundThe glutamic acid decarboxylase antibody (GADA) test, commonly used to diagnose autoimmune diabetes, is not cost-effective in areas of low prevalence. The aim of this study was to develop a convenient tool to discriminate adult-onset GADA-positive autoimmune diabetes from type 2 diabetes (T2DM) in patients with newly diagnosed diabetes.MethodsThis retrospective cross-sectional study, conducted at Changhua Christian Hospital in Taiwan, collected electronic medical record data from January 2009 to December 2018. Patients were divided into a case group (GADA+, n = 152) and a reference group (T2DM, n = 358). Variables that differed significantly between the groups were subjected to receiver operator characteristic analysis to establish cutoff values. Discriminant function analysis was then employed to discriminate the two groups.ResultsAt the onset of diabetes, the GADA+ group was younger, with lower body mass index (BMI), higher hemoglobin A1c (HbA1c), higher high-density lipoprotein cholesterol (HDL-C), and lower total cholesterol and triglycerides (TG). Five major factors were identified to form the linear discriminant functions: BMI, age at onset, TG, HDL-C, and HbA1c. BMI < 23 kg/m2 was the most important factor, followed by TG < 98 mg/dL, HDL-C ≥ 46 mg/dL, age at onset < 30 years, and HbA1c ≥ 8.6%. The overall accuracy of the linear discriminant functions was 87.1%, with 84.2% sensitivity and 88.3% specificity.ConclusionsRoutine tests in diabetes care were used to establish a convenient, low-cost tool that may assist in the early identification of adult-onset GAD+ autoimmune diabetes in clinical practice.
Highlights
In children and adolescents, type 1 diabetes (T1DM), known as autoimmune diabetes, usually presents with diabetic ketoacidosis (DKA) as the initial presentation and is relatively straightforward to diagnose
This study demonstrated that measuring serum TG and high-density lipoprotein cholesterol (HDL-C) levels at the onset of disease can be used to help discriminate glutamic acid decarboxylase antibody (GADA)+ autoimmune diabetes from type 2 diabetes mellitus (T2DM) in adults
To the best of our knowledge, the present study is the first to focus on TG and HDL-C combined with body mass index (BMI), age at onset, and hemoglobin A1c (HbA1c) to develop a practical discrimination tool to discriminate adult-onset GADA+ autoimmune diabetes from T2DM in ethnic Chinese patients
Summary
Type 1 diabetes (T1DM), known as autoimmune diabetes, usually presents with diabetic ketoacidosis (DKA) as the initial presentation and is relatively straightforward to diagnose. The period of insulin requirement after onset may allow differentiation between patients with latent autoimmune diabetes in adults (LADA) and those with classic adult-onset T1DM, who become insulin-dependent within 3 months of diagnosis (Buzzetti, Zampetti & Maddaloni, 2017). In the absence of autoantibody testing, it is not uncommon for it to be diagnosed and treated as type 2 diabetes (T2DM) (Buzzetti, Zampetti & Maddaloni, 2017; Carlsson, 2019). The aim of this study was to develop a convenient tool to discriminate adult-onset GADApositive autoimmune diabetes from type 2 diabetes (T2DM) in patients with newly diagnosed diabetes. At the onset of diabetes, the GADA+ group was younger, with lower body mass index (BMI), higher hemoglobin A1c (HbA1c), higher high-density lipoprotein cholesterol (HDL-C), and lower total cholesterol and triglycerides (TG). Five major factors were identified to form the linear discriminant functions: BMI, age at onset, TG, HDL-C, and HbA1c. Routine tests in diabetes care were used to establish a convenient, lowcost tool that may assist in the early identification of adult-onset GAD+ autoimmune diabetes in clinical practice
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