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Utility of diabetes‐associated autoantibodies for classification of new onset diabetes in children and adolescents
Author(s) -
von Oettingen Julia E,
Wolfsdorf Joseph I,
Feldman Henry A,
Rhodes Erinn T
Publication year - 2016
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12304
Subject(s) - medicine , type 1 diabetes , diabetes mellitus , type 2 diabetes , logistic regression , autoantibody , cohort , pediatrics , endocrinology , immunology , antibody
Objective To determine whether measuring diabetes‐associated autoantibodies ( DAA ) in pediatric new onset diabetes ( NODM ) can be restricted to patients with equivocal diabetes type. Research design and methods Retrospective analysis of all patients with NODM admitted to Boston Children's Hospital from 1 October 2007 to 1 July 2013 who had measurement of DAA [glutamic acid decarboxylase, insulin, insulinoma‐associated antigen 2 ( IA ‐2)]. Data collection included initial diagnosis of diabetes type before DAA results and at follow‐up. We used logistic regression to predict type 1 diabetes ( T1D ) and developed a clinical score to classify diabetes type. Results Of 1089 patients (45.4% female, 76.7% White, age 10.6 ± 4.5 yr), initial diagnosis was 1021 (93.8%) T1D , 42 (3.9%) type 2 diabetes ( T2D ), and 26 (2.4%) other. Of 993 patients with clinical T1D , 78 (7.9%) were DAA −, and of 42 patients with clinical T2D , 12 (28.6%) were DAA +. Type of diabetes was reclassified at follow‐up in less than 6% of patients. Data from a subset of 736 patients were used to develop a scoring system to predict T1D . Using weight z‐score, age, and race, the scoring system had 91.7% sensitivity, 82% specificity, and a positive predictive value of 98.6%, and suggested DAA measurement was unnecessary in 85.3% of patients. Findings were similar in a validation cohort of 234 patients. Conclusions Application of a simple scoring system may reduce to ∼15% the number of DAA measurements needed to classify diabetes type, resulting in substantial cost savings. Clinical judgment should guide the decision to measure DAA .