Sia Hon-Ke, Tu Shih-Te, Liao Pei-Yung, Lin Kuan-Han, Kor Chew-Teng, Yeh Ling-Ling
Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
Department of Healthcare Administration, Asia University, Taichung City, Taiwan.
PeerJ. 2020 Feb 14;8:e8610. doi: 10.7717/peerj.8610. eCollection 2020.
The glutamic acid decarboxylase antibody (GADA) test, commonly used to diagnose autoimmune diabetes, is not cost-effective in areas of low prevalence. The aim of this study was to develop a convenient tool to discriminate adult-onset GADA-positive autoimmune diabetes from type 2 diabetes (T2DM) in patients with newly diagnosed diabetes.
This retrospective cross-sectional study, conducted at Changhua Christian Hospital in Taiwan, collected electronic medical record data from January 2009 to December 2018. Patients were divided into a case group (GADA+, = 152) and a reference group (T2DM, = 358). Variables that differed significantly between the groups were subjected to receiver operator characteristic analysis to establish cutoff values. Discriminant function analysis was then employed to discriminate the two groups.
At the onset of diabetes, the GADA+ group was younger, with lower body mass index (BMI), higher hemoglobin A1c (HbA1c), higher high-density lipoprotein cholesterol (HDL-C), and lower total cholesterol and triglycerides (TG). Five major factors were identified to form the linear discriminant functions: BMI, age at onset, TG, HDL-C, and HbA1c. BMI < 23 kg/m was the most important factor, followed by TG < 98 mg/dL, HDL-C ≥ 46 mg/dL, age at onset < 30 years, and HbA1c ≥ 8.6%. The overall accuracy of the linear discriminant functions was 87.1%, with 84.2% sensitivity and 88.3% specificity.
Routine tests in diabetes care were used to establish a convenient, low-cost tool that may assist in the early identification of adult-onset GAD+ autoimmune diabetes in clinical practice.
常用于诊断自身免疫性糖尿病的谷氨酸脱羧酶抗体（GADA）检测，在低患病率地区不具有成本效益。本研究的目的是开发一种便捷工具，以区分新诊断糖尿病患者中成年发病的GADA阳性自身免疫性糖尿病与2型糖尿病（T2DM）。
这项回顾性横断面研究在台湾彰化基督教医院进行，收集了2009年1月至2018年12月的电子病历数据。患者分为病例组（GADA +，n = 152）和参照组（T2DM，n = 358）。对两组间有显著差异的变量进行受试者操作特征分析以确定临界值。然后采用判别函数分析来区分两组。
在糖尿病发病时，GADA +组更年轻，体重指数（BMI）更低，糖化血红蛋白（HbA1c）更高，高密度脂蛋白胆固醇（HDL-C）更高，总胆固醇和甘油三酯（TG）更低。确定了五个主要因素以形成线性判别函数：BMI、发病年龄、TG、HDL-C和HbA1c。BMI < 23 kg/m²是最重要的因素，其次是TG < 98 mg/dL、HDL-C≥46 mg/dL、发病年龄< 30岁和HbA1c≥8.6%。线性判别函数的总体准确率为87.1%，敏感性为84.2%，特异性为88.3%。
利用糖尿病护理中的常规检测建立了一种便捷、低成本的工具，可在临床实践中协助早期识别成年发病的GAD +自身免疫性糖尿病。
