Fourlanos et al developed a clinical screening tool to help identify adults with latent autoimmune diabetes mellitus (LADA). This can select patients for additional testing to detect islet cell autoantibodies. The authors are from the Walter and Eliza Hall Institute of Medical Research in Parkville, Victoria, Australia.
Parameters:
(1) body mass index (BMI)
(2) age at diabetes onset
(3) acute symptoms prior to diagnosis (one or more of polydipsia, polyuria or unintentional weight loss)
(4) personal history of DR3 or DR4-related autoimmune disease
(5) family history of DR3 or DR4-related autoimmune disease
DR3 or DR4-related autoimmune diseases include:
(1) autoimmune thyroid disease
(2) celiac disease
(3) Addison's disease
(4) vitiligo
(5) rheumatoid arthritis
(6) pernicious anemia
(7) autoimmune hepatitis
|
Parameter
|
Finding
|
Points
|
|
body mass index
|
< 25 kg per square meter
|
1
|
|
|
>= 25 kg per square meter
|
0
|
|
age at diabetes onset
|
< 50 years of age
|
1
|
|
|
>= 50 years of age
|
0
|
|
acute symptoms prior to diagnosis of diabetes
|
absent
|
0
|
|
|
present
|
1
|
|
personal history of DR3 or DR4 related autoimmune disease
|
absent
|
0
|
|
|
present
|
1
|
|
family history
|
absent
|
0
|
|
|
present
|
1
|
clinical risk score =
= SUM(points for all 5 parameters)
multivariate LADA clinical risk score =
= (1.85 * (points for age of onset)) + (1.29 * (points for BMI)) + (1.37 * (points for acute symptoms)) + (1.14 * (points for personal history))
Interpretation:
• minimum clinical risk score: 0
• maximum clinical risk score: 5
• minimum multivariate LADA score: 0
• maximum multivariate LADA score: 5.65
• The cutoff for the clinical risk score is >= 2.
• The cutoff for the multivariate LADA score was >= 1.37.
Performance:
• A clinical risk score >= 2 had a sensitivity of 75% and specificity of 77%.
• A multivariate LADA score >= 1.37 had a sensitivity of 76% and specificity of 77%.
• A clinical risk score <= 1 had a 99% negative predictive value for LADA.
