A Clinical Screening Tool Identifies Autoimmune Diabetes in Adults: Response to Davis et al.

We thank Davis et al. (1) for their comments regarding the recent publication of a clinical screening tool for latent autoimmune diabetes in adults (LADA) (2). It is appreciated that the authors’ routine management of “poorly controlled adult type 2 diabetes” incorporates the “LADA instrument components.” However, our observations of the management of such patients by internists and diabetes nurse practitioners in the community are often contrary to the practice of the authors. Adults with suboptimal glycemic control due to declining β-cell function (often secondary to autoimmune disease) are underrecognized, leading to delays in commencing insulin therapy. The clinical screening tool was developed to aid primary care physicians and diabetes nurse practitioners to consider the pathophysiological process of autoimmune β-cell destruction. The authors cite that the positive predictive value of the clinical screening tool is low at 21% but do not mention that the negative predictive value of the tool is 99%; hence, the tool is highly reliable at excluding LADA and has a sensitivity of 90%, meaning that most LADA patients can be identified with the assistance of this noninvasive and cost-free clinical screening tool.