The potential of anti-glutamic acid decarboxylase antibodies to support a diagnosis of autoimmune diabetes mellitus.

IF 2.5 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinical biochemistry Pub Date : 2024-11-15 DOI:10.1016/j.clinbiochem.2024.110842

Maryah Liepert, Shamayel Alhaqqan, Alaa Husain, Heather Lochnan, Ronald A Booth, Julie Shaw, Cathy J Sun

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Abstract

Objective: Anti-glutamic acid decarboxylase (anti-GAD) antibodies are a frequently used diagnostic marker for autoimmune forms of diabetes mellitus (DM), namely, type 1 diabetes mellitus (T1DM) and latent autoimmune diabetes in adults (LADA). We sought to provide insight into a unique diagnostic application of anti-GAD antibodies in patients potentially misdiagnosed with type 2 diabetes mellitus (T2DM).

Methods: We present a case series of patients who had a change in diagnosis from T2DM to autoimmune DM that was supported by positive anti-GAD antibodies. Patients were identified via a retrospective chart review of all anti-GAD antibodies tests ordered between 1 January 2020 and 31 December 2021 at a tertiary care academic hospital.

Results: Of the 23 patients with previous diagnosis of T2DM, positive anti-GAD antibodies supported the clinician's decision to change the diagnosis to autoimmune DM. The prominent clinical reasons for ordering anti-GAD antibodies in patients previously diagnosed as T2DM were patient presentation with diabetic ketoacidosis, features of insulin insufficiency, inadequate effect of oral diabetes mellitus medications, young age at diagnosis, and a family history of autoimmune conditions.

Conclusion: Anti-GAD antibodies' positivity can support a change in diagnosis from T2DM to autoimmune DM, which has substantial impact on patient care. Timely and reliable clinical laboratory reporting of anti-GAD antibodies is highly recommended.

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抗谷氨酸脱羧酶抗体支持自身免疫性糖尿病诊断的潜力。

目的：抗谷氨酸脱羧酶（anti-GAD）抗体是自身免疫性糖尿病（DM），即1型糖尿病（T1DM）和成人潜伏自身免疫性糖尿病（LADA）的常用诊断标志物。我们试图深入了解抗GAD抗体在可能被误诊为2型糖尿病（T2DM）患者中的独特诊断应用：我们展示了一系列病例，这些患者的诊断由T2DM转变为自身免疫性DM，抗GAD抗体阳性支持了诊断结果。我们对一家三级医疗学术医院在 2020 年 1 月 1 日至 2021 年 12 月 31 日期间开具的所有抗 GAD 抗体检测单进行了回顾性病历审查，从而确定了患者：结果：在23名先前诊断为T2DM的患者中，抗GAD抗体阳性支持临床医生将诊断改为自身免疫性DM的决定。先前被诊断为T2DM的患者订购抗-GAD抗体的主要临床原因是患者出现糖尿病酮症酸中毒、胰岛素分泌不足、口服糖尿病药物效果不佳、诊断时年龄较小、有自身免疫性疾病家族史：抗-GAD抗体阳性可支持从T2DM到自身免疫性DM的诊断改变，这对患者护理有重大影响。我们强烈建议临床实验室及时、可靠地报告抗-GAD抗体。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical biochemistry 医学-医学实验技术

CiteScore

5.10

自引率

0.00%

发文量

151

审稿时长

25 days

期刊介绍： Clinical Biochemistry publishes articles relating to clinical chemistry, molecular biology and genetics, therapeutic drug monitoring and toxicology, laboratory immunology and laboratory medicine in general, with the focus on analytical and clinical investigation of laboratory tests in humans used for diagnosis, prognosis, treatment and therapy, and monitoring of disease.