Development and validation of a clinical score for identifying patients with high risk of latent autoimmune adult diabetes (LADA): The LADA primary care-protocol study.

BACKGROUND: Latent autoimmune diabetes in adults (LADA) is a type of diabetes mellitus showing overlapping characteristics between type 1 Diabetes Mellitus and type 2 Diabetes Mellitus (T2DM), and autoimmunity against insulin-producing pancreatic cells. For its diagnosis, at least one type of anti-pancreatic islet antibody (GADAb is the most common) is required. Many authors recommend performing this measure in all newly diagnosed patients with DM, but it is not possible in Primary Health Care (PHC) due to its high cost. Currently, a relevant proportion of patients diagnosed as T2DM could be LADA. Confusing LADA with T2DM has clinical and safety implications, given its different therapeutic approach. The main objective of the study is to develop and validate a clinical score for identifying adult patients with DM at high risk of LADA in PHC. METHODS: This is an observational, descriptive, cross-sectional study carried out in Primary Care Health Centers with a centralized laboratory. All people over 30 years of age diagnosed with diabetes within a minimum of 6 months and a maximum of 4 years before the start of the study will be recruited. Individuals will be recruited by consecutive sampling. The study variables will be obtained through clinical interviews, physical examinations, and electronic medical records. The following variables will be recorded: those related to Diabetes Mellitus, sociodemographic, anthropometric, lifestyle habits, laboratory parameters, presence of comorbidities, additional treatments, personal or family autoimmune disorders, self-perceived health status, Fourlanos criteria, and LADA diagnosis (as main variable) according to current criteria. DISCUSSION: The study will provide an effective method for identifying patients at increased risk of LADA and, therefore, candidates for antibody testing. However, a slight participation bias is to be expected. Differences between participants and non-participants will be studied to quantify this potential bias.

Using prefrailty to detect early disability.

INTRODUCTION: In an aging population, new strategies are required to identify individuals at risk of adverse health outcomes. Frailty syndrome is related to negative health events. This increased risk may be used to identify individuals in which interventions can delay the onset of physical and functional complications. The aim of the study was to determine the relationship between the onset of frailty and the beginning of functional disability. MATERIALS AND METHODS: This was a cross-sectional observational study with consecutive sampling to analyze 146 patients aged seventy and older who come to the primary care center. The level of frailty was registered according to fatigue, resistance, ambulation, illnesses, and loss of weight scale. Disability for Instrumental Activities of Daily Live dependency, comorbidity, and social risk factors was registered too. RESULTS: The prevalence of frailty and prefrailty was 17.8% and 39%, respectively, and were associated with age, level of disability, and the presence of gastrointestinal disease. Prefrail patients had initial levels of dependency, while those who were not frail were mostly independent. CONCLUSION: Frailty syndrome is easily detectable. The intermediate stage known as prefrailty is related to the start of the functional disability. The syndrome screening identifies individuals at risk in whom we can potentially intervene to delay the onset of the syndrome and delay functional disability. Control of comorbidity in frail patients must be studied. Screening age could be set in patients between 75 and 81 years old.