primary care diabetes 2 ( 2 0 0 8 ) 207–211 available at www.sciencedirect.com journal homepage: http://www.intl.elsevierhealth.com/journals/pcd/ Brief report Easily obtainable clinical features increase the diagnostic accuracy for latent autoimmune diabetes in adults: An evidence-based report Maurice W.M.D. Lutgens a,1 , Melanie Meijer a,1 , Babette Peeters a,1 , Marie-Louise N.F. Poulsen a,1 , Marjet J. Rutten a,1 , Michiel L. Bots b,1 , Geert J.M.G. van der Heijden b,1 , Sabita S. Soedamah-Muthu b,*,1 a University Medical Center Utrecht, Faculty of Medicine, The Netherlands b Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands article info Article history: Received 15 October 2007 Received in revised form 13 January 2008 Accepted 13 August 2008 Published on line 23 September 2008 Keywords: Latent autoimmune diabetes in adults Diagnosis Screening Evidence-based medicine abstract Background: Latent autoimmune diabetes in adults (LADA) represents a subgroup of diabetes mellitus. LADA is characterised by adult-onset diabetes and circulating autoimmune anti- bodies. LADA patients may need a different therapeutic approach than the usual type 2 diabetes mellitus. When LADA is inadequately diagnosed as type 2 diabetes mellitus, LADA patients will mistakenly be exposed to a high dose of oral glucose lowering drugs and their possible side effects. Aim: To assess which clinical features predict the presence or absence of LADA in patients older than 25 years presenting with hyperglycemia. Methods: A structured Medline and Embase search was conducted. Titles and abstracts were screened using predetermined selection criteria. Critical appraisal was based on standard- ized validity criteria for diagnostic research. Results: One-hundred and eighty-four papers were retrieved of which after assessment of relevance and validity 2 studies remained for further analysis. One study reported a prob- ability of LADA of 0.99 with one or two out of the following five clinical features: age at onset <50 years; acute symptoms; BMI < 25 kg/m 2 ; a history of autoimmune disease; a fam- ily history positive for diabetes mellitus. The other study reported a probability of LADA of zero with none of the following clinical features and of 0.32 with one out of three: fasting blood glucose ≥ 15 mmol/l and/or HbA 1c ≥ 10%; 10% reduction in body weight in the previous 3 months; BMI < 25 kg/m 2 . Conclusion: Further testing for LADA by measurement of autoimmune antibodies appears to be unnecessary in the absence of a specific set of clinical features. Before initiating therapy applying the above criteria may help to separate LADA from usual type 2 diabetes. © 2008 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. Abbreviations: GP, general practitioner; LADA, latent autoimmune diabetes in adults; GADA, glutamic acid decarboxylase antibodies; UKPDS, United Kingdom Prospective Diabetes Study; BMI, body mass index; PPV, positive predictive value; NPV, negative predictive value; NICE, National Institute for Health and Clinical Excellence; ADA, American Diabetes Association; ICA, Islet cell antibodies. * Corresponding author at: University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Huispostnr str.6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 75 59379; fax: +31 88 75 55485. E-mail address: s.s.soedamah-muthu@umcutrecht.nl (S.S. Soedamah-Muthu). 1 All authors contributed equally to this manuscript. 1751-9918/$ – see front matter © 2008 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.pcd.2008.08.003