Time to insulin initiation cannot be used in defining latent autoimmune diabetes in adults.
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.


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).


CONCLUSIONS
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.
Brophy
Sinead
S
School of Medicine, Swansea University, Swansea SA2 8PP, UK. s.brophy@swansea.ac.uk
Yderstraede
Knud
K
Mauricio
Didac
D
Hunter
Stephen
S
Hawa
Mohammed
M
Pozzilli
Paolo
P
Schernthaner
Guntram
G
Schloot
Nanette
N
Schoot
Nanette
N
Buzzetti
Raffaella
R
Davies
Helen
H
Leslie
David
D
Williams
Rhys
R
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008875:Middle Aged; D013997:Time Factors
D001323:Autoantibodies; D007004:Hypoglycemic Agents; D007328:Insulin; D005968:Glutamate Decarboxylase