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Published online December 14, 2007
Diabetes Care 31:439-441, 2008
DOI: 10.2337/dc07-1308
© 2008 by the American Diabetes Association
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Clinical Care/Education/Nutrition/Psychosocial Research
Original Research

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

Sinead Brophy, PHD1, Knud Yderstræde, PHD2, Didac Mauricio, PHD3, Stephen Hunter, PHD4, Mohammed Hawa, PHD5, Paolo Pozzilli, PHD6, Guntram Schernthaner, PHD7, Nanette Schoot, PHD8, Raffaella Buzzetti, PHD9, Helen Davies, PHD1, David Leslie, PHD5, Rhys Williams, PHD1 on behalf of the Action LADA Group*

1 School of Medicine, Swansea University, Swansea, U.K
2 Department of Endocrinology, University Hospital of Odense, Odense, Denmark
3 Department of Endocrinology and Nutrition, Hospital de Sant Pau, Barcelona, Spain
4 Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, U.K
5 Department of Diabetes and Molecular Medicine, St. Bartholomew's Hospital, London, U.K
6 Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
7 Department of Medicine, Rudolfstiftung Hospital, Vienna, Austria
8 German Diabetes Centre, University of Duesseldorf, Duesseldorf, Germany
9 Dipartimento Scienze Cliniche, University of Rome, Sapienza, Italy

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

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.

Abbreviations: GADA, GAD antibody • LADA, latent autoimmune diabetes


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