Open AccessDifferential diagnostic utilities of combined testing for islet cell antibody, glutamic acid decarboxylase antibody, and tyrosine phosphatase antibody
Author(s) -
Alexei V. Timofeev,
Тимофеев Алексей Валентинович,
И. Е. Колтунов,
Колтунов Игорь Ефимович,
Е. Е. Петряйкина,
Петряйкина Елена Ефимовна,
И Г Рыбкина,
Рыбкина Ирина Георгиевна,
Л. Н. Самсонова,
Самсонова Любовь Николаевна,
Anatoly Tiulpakov,
Тюльпаков Анатолий Николаевич,
N. V. Zubkova,
Зубкова Наталья Анатольевна,
Irina Kolomina,
Коломина Ирина Геннадьевна,
Evgenia A. Evsjukova,
Евсюкова Евгения Александровна,
Sergey S. Bukin,
Букин Сергей Сергеевич,
Alexey C. Khrushchev,
Хрущев Алексей Константинович
Publication year - 2018
Publication title -
saharnyj diabet
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.155
H-Index - 12
eISSN - 2072-0378
pISSN - 2072-0351
DOI - 10.14341/dm9364
Subject(s) - type 1 diabetes , medicine , antibody , islet , pre and post test probability , diabetes mellitus , immunology , endocrinology
Background. Beta-cell antibody tests are used for the differential diagnosis of diabetes mellitus. They permit to discriminate between the type 1 diabetes (T1D) and non-autoimmune diabetes types. To choose an appropriate test for ruling in or ruling out the T1D a physician needs to know how conclusive test results are. The most powerful estimate of test conclusiveness is its likelihood ratio (LHR). The higher LHR of a positive result (LHR+), the more posttest probability of T1D; the lower LHR of a negative result (LHR), the less posttest probability of T1D.
Aims. To compare conclusiveness of single and combined tests for antibodies to islet cells (ICA), glutamate decarboxylase (GADA), and tyrosine phosphatase IA-2 (IA-2A), and to evaluate posttest probabilities of T1D at various pretest probabilities.
Methods. All antibodies were tested in parallel in 169 children and adolescents with a new-onset T1D, and in 169 persons without this disease. ICA, GADA, and IA-2A were determined by indirect immunofluorescence, radioimmune assay, and ELISA, respectively. LHR+ and LHR were calculated with the MedCalc Statistical Software. Posttest T1D probabilities were calculated from Bayes theorem-based equation.
Results. Among single tests, an ICA test had the greatest LHR+ and the smallest LHR, and consequently was the most reliable either for ruling in or ruling out the T1D. Among test combinations, an ICAGADA combination had the greatest LHR+ and was the most suitable for T1D confirmation. The triple combination ICAGADAIA-2A had the smallest LHR and was the most suitable for T1D exclusion.
Conclusions. In the differential diagnosis of diabetes, the most appropriate test for ruling in the T1D is the double combination ICAGADA. With both antibodies positive, this combination provides the highest posttest T1D probabilities at any pretest probability. The most appropriate test for ruling out the T1D is the triple combination ICAGADAIA-2A. With all three antibodies negative, this combination provides the lowest posttest T1D probabilities.