Impact of GAD-65 Antibody Detection on Antihyperglycemic Therapy in T2D

Guidelines recommend Latent Autoimmune Diabetes in Adults be managed similar to type 1 diabetes, emphasizing early insulin initiation, while other guidances suggest incorporating non-insulin antihyperglycemic therapies based on comorbidities and C-peptide levels. The study objective was to explore whether glutamic acid decarboxylase-65 autoantibody detection in individuals diagnosed with type 2 diabetes impacts antihyperglycemic treatment. This retrospective, observational cohort study at an academic integrated delivery network in Northeast Ohio utilized electronic medical records. Included individuals were previously diagnosed with type 2 diabetes and tested positive for glutamic acid decarboxylase-65 autoantibodies between 9/1/2021 and 9/1/2023. The primary outcome compared the median number of non-insulin antihyperglycemic classes at the time of autoantibody detection and after 12 months. Participants had a mean age of 57.2 ± 13.7 years, 73.3% white, with a median body mass index of 26.2 kg/m2, and 82.1% had an estimated glomerular filtration rate greater than 60 mL/min/1.73 m2. A median of 1 (0-2) non-insulin antihyperglycemic classes were present at detection and 1 (0-1.5) post-detection (P < 0.0001). Significantly fewer individuals were prescribed metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, sulfonylureas, and thiazolidinediones, whereas significantly more individuals were prescribed bolus insulin post-detection. While most individuals had a baseline C-peptide within 12 months prior to detection, significantly fewer C-peptide assessments occurred during the subsequent 12-month follow-up period. In individuals with type 2 diabetes, glutamic acid decarboxylase-65 autoantibody detection was associated with significantly fewer non-insulin antihyperglycemics prescribed and significantly more insulins at 12 months post-detection.