Key result
LADA screening in new-onset diabetes remains ~1% and declines with age despite constant positivity.
Why the study?
Latent autoimmune diabetes (LADA) may affect 2-12% of adults with new-onset diabetes mellitus but is often underdiagnosed, leading investigators to examine real-world screening rates.
Cohort (n=8,036,272)
Yes
p-value: p=<0.0005
LADA screening rates are extremely low among adults with new-onset diabetes in the U.S., particularly in older patients, suggesting significant under-screening for autoimmune diabetes.
Low LADA screening rates suggest underdiagnosis risk; hypothesis-generating for age-specific screening trials.
Introduction and Objective: Latent autoimmune diabetes (LADA) may affect between 2-12% of adults with new-onset diabetes mellitus (DM) but is often underdiagnosed. We investigated LADA screening rates among adults with new-onset diabetes within a nationwide U.S. cohort. Methods: Epic Cosmos is a dataset representing over 300 million patients. We determined the rates at which C-peptide levels and glutamic acid decarboxylase (GAD) antibodies were checked in U.S. patients over 30 years of age with a first problem list entry for either type 1 or type 2 DM between 2020 and 2025. We also analyzed antibody positive rates by age, body mass index (BMI), hemoglobin A1c, race, and ethnicity. Results: Among adults over 30 years of age with new-onset DM (n=8,036,272), 0.71% were screened for low C-peptide, and 0.54% were screened for anti-GAD antibodies. Antibody screening rates were 2.56% for patients between 30-40 years of age, 1.13% for ages 40-50 years, 0.61% for 50-60 years, and 0.25% for those over 60 years, with positivity rates of 24%, 18%, 17%, and 17%, respectively. Rates were 0.88% (24% positive) for patients with BMI of less than 30 kg/m2, 0.46% (13% positive) for BMI 30 to 35, and 0.42% (11% positive) for BMI above 35. Screening rates were 0.23% (15% positive) for patients with A1c less than 7%, 0.43% (22% positive) for A1c 7-8%, 0.75% (23% positive) for A1c 8-9%, and 3.3% (19% positive) for A1c above 9%. Black patients were most likely to be screened (0.88%; 16% positive), followed by Asian (0.49%; 10% positive) and white (0.43%; 22% positive) patients. Differences between groups were all statistically significant (χ2 p-values < 0.0005). The most screened patients were 30-40 years of age with BMI less than 30 and A1c above 9%, with a screening rate of 10% (35% positive). Conclusion: In this nationwide cohort, LADA screening rates were low, with higher rates in younger patients, those with lower BMI, and higher A1c. Screening rates declined with age whereas positivity rates remained constant among patients over 40 years of age, suggesting older patients may be under-screened. Disclosure A. Liu: None. J.Q. Core: None. M. O'Connor: None.
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Liu et al. (2026) conducted a cohort in new-onset diabetes mellitus (n=8,036,272). LADA screening (C-peptide and GAD antibodies) was evaluated on Rates of screening for low C-peptide and anti-GAD antibodies (p=<0.0005). Among over 8 million adults with new-onset diabetes, LADA screening rates were low (0.71% for C-peptide, 0.54% for anti-GAD), with screening declining with age despite constant positivity rates.
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