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Time to insulin initiation can not be used in defining Latent Autoimmune Diabetes in Adults [LADA].

Dr S Brophy PhD and H Davies MSc and Professor R Williams MD. Swansea University, Swansea, UK
University Hospital of Odense, Odense
Dr Yderstraede MD, PhD, University Hospital of Odense, Odense
Dr Hunter, MD, Royal Victoria Hospital, Belfast
Professor Leslie, MD and Mr Hawa BSc, St Bartholomew's Hospital, London
Professor Pozzilli MD, University Campus Bio-Medico, Rome
Professor Schernthaner MD, Rudolfstiftung Hospital, Vienna
Dr Schloot, MD,German Diabetes Centre, University of Duesseldorf, Duesseldorf
Professor Buzzetti MD, Sapienza, University of Rome

s.brophy{at}swansea.ac.uk

ABSTRACT

Objective: Latent Autoimmune Diabetes in Adults [LADA] 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.

Methods: Patients were recruited in 9 European centres and clinicians reported on criteria for initiating insulin. All patients were tested for glutamic acid decarboxylase autoantibodies (GADA) in a central laboratory. We examined time to insulin treatment for GADA positive patients in 6 participating centres.

Results: There was inter-centre variation in the criteria used to initiate insulin. Median time to insulin was 16.15 months (IQR: 6.7 – 25.5) in centres with GADA testing compared to 45.6 months (IQR: 29.5-61.8) in centres without routine GADA testing (p<0.002).

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

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