Diagnostic Accuracy in LADA—Low Correlation between Primary Care Physicians (PCPs) and an Endocrinologist

Background: Patients with LADA benefit from different interventions than those with T2D. However, distinguishing one entity from the other may be challenging in individual patients. We hypothesized that LADA is being underdiagnosed by PCPs.

Methods: We retrospectively reviewed the medical charts of 1257 patients that consecutively presented to our diabetes clinic from 2001-10. Inclusion criteria were: age >18 years, having diabetes, and having been assessed by one of our investigators upon presentation. We collected demographic, clinical, and laboratorial data from their first visit to our clinic.

Findings: Of 1257 only 6 (0.5%) were referred to our clinic with a diagnosis of LADA. In contrast, we identified a total of 133 individuals with LADA (10.6%). There was good correlation between PCPs and an endocrinologist in the diagnosis of common diabetes subtypes like T1D and T2D, but it was poor for less common diabetes subtypes including LADA (Table). Most of the patients with LADA were originally classified as T2D (n=105). Seven percent of patients with LADA in our population had a history of DKA.

Interpretation: LADA is currently being underdiagnosed by PCPs. Strategies to raise awareness of the existence of this patient population as well as cost-effective strategies to identify them are largely needed.