Time to Insulin Initiation Cannot Be Used in Defining Latent Autoimmune Diabetes in Adults

  1. Sinead Brophy, PHD1,
  2. Knud Yderstræde, PHD2,
  3. Didac Mauricio, PHD3,
  4. Stephen Hunter, PHD4,
  5. Mohammed Hawa, PHD5,
  6. Paolo Pozzilli, PHD6,
  7. Guntram Schernthaner, PHD7,
  8. Nanette Schoot, PHD8,
  9. Raffaella Buzzetti, PHD9,
  10. Helen Davies, PHD1,
  11. David Leslie, PHD5,
  12. Rhys Williams, PHD1 and
  13. on behalf of the Action LADA Group*
  1. 1School of Medicine, Swansea University, Swansea, U.K
  2. 2Department of Endocrinology, University Hospital of Odense, Odense, Denmark
  3. 3Department of Endocrinology and Nutrition, Hospital de Sant Pau, Barcelona, Spain
  4. 4Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, U.K
  5. 5Department of Diabetes and Molecular Medicine, St. Bartholomew's Hospital, London, U.K
  6. 6Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
  7. 7Department of Medicine, Rudolfstiftung Hospital, Vienna, Austria
  8. 8German Diabetes Centre, University of Duesseldorf, Duesseldorf, Germany
  9. 9Dipartimento Scienze Cliniche, University of Rome, Sapienza, Italy
  1. Address correspondence and reprint requests to Dr. Sinead Brophy, School of Medicine, Swansea University, Swansea SA2 8PP, U.K. E-mail: s.brophy{at}swansea.ac.uk

Abstract

OBJECTIVE—Latent autoimmune diabetes in adults is type 1 diabetes presenting as non–insulin dependent diabetes. One feature of the selection criteria is time independent of insulin treatment. We examine the validity of this criterion.

RESEARCH DESIGN AND METHODS—Patients were recruited in nine European centers, and clinicians reported on criteria for initiating insulin. All patients were tested for GAD antibodies (GADAs) in a central laboratory. We examined time to insulin treatment for GADA-positive patients in six participating centers.

RESULTS—There was intercenter variation in the criteria used to initiate insulin. Median time to insulin was 16.15 months (interqartile range 6.7–25.5) in centers with GADA testing compared with 45.6 months (29.5–61.8) in centers without routine GADA testing (P < 0.002).

CONCLUSION—Time to insulin should not be used to define patients with LADA because it is dependent on local clinical judgment and the use of laboratory tests for GADA.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 14 December 2007. DOI: 10.2337/dc07-1308.

  • *

    ↵* A full list of the members of the Action LADA Group can be found in an online appendix at http://dx.doi.org/10.2337/dc07-1308.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted December 10, 2007.
    • Received July 9, 2007.
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  1. Published online before print December 14, 2007, doi: 10.2337/dc07-1308 Diabetes Care March 2008 vol. 31 no. 3 439-441
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