ArticleDiabetologia2021
Improving clinical utility of GAD65 autoantibodies by electrochemiluminescence assay and clinical phenotype when identifying autoimmune adult-onset diabetes.
Article in Diabetologia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 25 citations in OpenAlex.
- Screening and Monitoring for Presymptomatic Type 1 Diabetes: A Time for Action.Hormone research in paediatrics · 2026Review
- Identifying Insulin Autoantibodies With Differential Risk in Type 1 Diabetes With a Novel Bridging ELISA.Diabetes · 2026Article
- A Case Report of Anti-GAD65 Antibody-Positive Autoimmune Encephalitis Associated with Diabetes.Endocrine, metabolic & immune disorders drug targets · 2026Article
- The Heterogeneity of Type 1 Diabetes: Implications for Pathogenesis, Prevention, and Treatment-2024 Diabetes, Diabetes Care, and Diabetologia Expert Forum.Diabetes care · 2025Review
- Review
- The heterogeneity of type 1 diabetes: implications for pathogenesis, prevention, and treatment-2024 Diabetes, Diabetes Care, and Diabetologia Expert Forum.Diabetologia · 2025Review
- Enhanced Electrochemiluminescence from Ruthenium-Tagged Immune Complex at Flexible Chains for Sensitive Analysis of Glutamate Decarboxylase Antibody.Biosensors · 2025Article
- Prognosis and outcome of latent autoimmune diabetes in adults: T1DM or T2DM?Diabetology & metabolic syndrome · 2024Review
- Prediction of future insulin-deficiency in glutamic acid decarboxylase autoantibody enzyme-linked immunosorbent assay-positive patients with slowly-progressive type 1 diabetes.Journal of diabetes investigation · 2024Article
- GAD65Abs Are Not Associated With Beta-Cell Dysfunction in Patients With T2D in the GRADE Study.Journal of the Endocrine Society · 2024 · on this mapArticle
- Understanding Islet Autoantibodies in Prediction of Type 1 Diabetes.Journal of the Endocrine Society · 2023Review
- Adult-onset autoimmune diabetes.Nature reviews. Disease primers · 2022Review
- High-Throughput Multiplex Electrochemiluminescence Assay Applicable to General Population Screening for Type 1 Diabetes and Celiac Disease.Diabetes technology & therapeutics · 2022Article
- Effective assay technologies fit for large-scale population screening of type 1 diabetes.Frontiers in clinical diabetes and healthcare · 2022Review
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Authors and funding
12 authors at 6 institutions in 3 countries.
Funding
Abstract
aims/hypothesisIt is important to differentiate the two major phenotypes of adult-onset diabetes, autoimmune type 1 diabetes and non-autoimmune type 2 diabetes, especially as type 1 diabetes presents in adulthood. Serum GAD65 autoantibodies (GADA) are the most sensitive biomarker for adult-onset autoimmune type 1 diabetes, but the clinical value of GADA by current standard radiobinding assays (RBA) remains questionable. The present study focused on the clinical utility of GADA differentiated by a new electrochemiluminescence (ECL) assay in patients with adult-onset diabetes.
methodsTwo cohorts were analysed including 771 diabetic participants, 30-70 years old, from the Action LADA study (n = 6156), and 2063 diabetic participants, 20-45 years old, from the Diabetes in Young Adults (DiYA) study. Clinical characteristics of participants, including requirement of early insulin treatment, BMI and development of multiple islet autoantibodies, were analysed according to the status of RBA-GADA and ECL-GADA, respectively, and compared between these two assays.
resultsGADA was the most prevalent and predominant autoantibody, >90% in both cohorts. GADA positivity by either RBA or ECL assay significantly discriminated clinical type 1 from type 2 diabetes. However, in both cohorts, participants with ECL-GADA positivity were more likely to require early insulin treatment, have multiple islet autoantibodies, and be less overweight (for all p < 0.0001). However, clinical phenotype, age at diagnosis and BMI independently improved positive predictive value (PPV) for the requirement of insulin treatment, even augmenting ECL-GADA. Participants with GADA detectable by RBA, but not confirmed by ECL, had a phenotype more similar to type 2 diabetes. These RBA-GADA positive individuals had lower affinity GADA compared with participants in which GADA was confirmed by ECL assay. CONCLUSIONS/
interpretationDetection of GADA by ECL assay, given technical advantages over RBA-GADA, identified adult-onset diabetes patients at higher risk of requiring early insulin treatment, as did clinical phenotype, together allowing for more accurate clinical diagnosis and management.
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