DIAGNOSTIC ACCURACY OF BIOMARKERS FOR LATENT AUTOIMMUNE DIABETES IN ADULTS: AN INTEGRATIVE REVIEW

Diabetes Mellitus Type LADA (Latent Autoimmune Diabetes in Adults) represents a peculiar form of diabetes that combines features of Type 1 Diabetes and Type 2 Diabetes. This condition is notable for the presence of autoantibodies directed to pancreatic beta cells, suggesting an underlying autoimmune etiology. According to the United Kingdom Prospective Diabetes Study (UKPDS), a significant proportion of patients with DM (Diabetes Mellitus) diagnosed in adulthood (up to 12% of cases) have slowly progressive autoimmune diabetes, a type of diabetes known as LADA, with prevalent underdiagnosis in many instances, often attributed to its clinical presentation, which resembles Type 2 diabetes, leading to underestimation of the autoimmune component. Understanding the differences in pathophysiology between these forms of diabetes is essential for the development of accurate diagnostic strategies. Traditional biomarkers used in the diagnosis of type 1 diabetes, such as the presence of autoantibodies against pancreatic beta cells, may be useful in identifying LADA. However, it is important to consider that the progression of beta cell destruction in LADA is slower than in type 1 diabetes, and typical features of type 2 diabetes, such as insulin resistance, may also be present. Despite the similarities with type 1 diabetes, LADA usually manifests in adults and its progression is gradual and slower, often being confused with the diagnosis of type 2 diabetes. Manisha et al. established a worldwide prevalence of LADA of 5.1% among patients with T2DM and showed the role of the autoantibody GAD in the screening of LADA, also bringing awareness to the measurement of antibodies in the identification of the disease. From this perspective, the differential diagnosis of LADA is often challenging, due to the overlapping characteristics with other forms of diabetes, leading to misdiagnosis and delay in appropriate treatment. According to the guidelines of the Brazilian Diabetes Society (SBD), the diagnostic criteria for LADA type diabetes are: (1) age at diagnosis <30 years, (2) patients who present slow and progressive destruction of ? cells, presenting positive antibody dosage, and (3) patients who do not require insulin therapy during the first 6 months after diagnosis. Furthermore, Sia et al. found BMI <23 kg/m2 to be the most significant clinical predictive factor for distinguishing between type 2 Diabetes Mellitus (DM) and autoimmune DM in adults (>20 years) with newly diagnosed DM, followed by serum triglycerides <98 mg/dL, HDL >46 mg/dL, and HbA1c >8.6%. Therefore, analyzing the accuracy of LADA diagnostic biomarkers is essential for determining the appropriate therapeutic management and optimizing the patient's prognosis, understanding their diagnostic importance. By assessing them, it is possible to identify which tests or combinations of tests are most effective in distinguishing between LADA, type 1 and type 2 diabetes, allowing an early and accurate diagnosis, initiating appropriate treatment from the onset of the disease. This is essential to ensure an appropriate and personalized therapeutic approach, which takes into account the complexity of LADA's pathophysiology and its similarities and differences with other types of diabetes. Conduct an analysis of the literature regarding the accuracy of the main diagnostic biomarkers applied in the identification of Latent Autoimmune Diabetes in Adults (LADA). An integrative review on this topic is crucial to identify accurate diagnostic biomarkers that can distinguish LADA from other forms of diabetes, such as type 1 and type 2. Thus, such identification will not only help in the implementation of appropriate treatments from the beginning, improving clinical management and health outcomes for patients, but will also make it possible to avoid ineffective and potentially detrimental treatments to a better prognosis. This is a qualitative research of the integrative review type to identify productions on topics associated with the accuracy of diagnostic biomarkers of Latent Autoimmune Diabetes in Adults (LADA). The integrative review provides the synthesis of knowledge and the applicability of significant studies in practice and is indicated as an important tool in the health field. To construct this research, the PICO strategy will be used as a basis for structuring a clear and targeted research question. PICO is an acronym that stands for: patient, problem or population of interest (P); intervention (I); comparison ©; and result, from the English “outcome” (O). This makes it easier to search for relevant evidence and analyze the results. The search for articles will be carried out in the following databases: PubMed, BVS, Scielo, Google Scholar. The search for articles will be carried out in the following databases: PubMed, BVS, Scielo, Google Scholar. The research will follow the following inclusion criteria: a) be a research article; b) be available in full text; c) studies available in Portuguese, English or Spanish; d) have been published between 2014 and 2024; e) articles that address the theme (biomarkers for the diagnosis of LADA-type Diabetes Mellitus). As exclusion criteria, texts that were not related to the theme and/or presented duplicates, in addition to those that fit into case reports, were disregarded. The aim is to identify knowledge gaps regarding the accuracy of diagnostic biomarkers of latent autoimmune diabetes in adults.