Prevalence of latent autoimmune diabetes in adults in China: a systematic review and meta-analysis

Background Studies of the prevalence of latent autoimmune diabetes in adults in China have reported inconsistent findings. We did a systematic review and meta-analysis to estimate the prevalence of latent autoimmune diabetes in adults in China. Methods For the systematic review, we searched PubMed, Embase, China Knowledge Resource Integrated Database, and Wanfang Medicine Database to identify studies investigating the prevalence of latent autoimmune diabetes in adults in China. In our meta-analysis we included hospital-based studies that recruited patients with newly diagnosed (less than 1 year from diagnosis) type 2 diabetes or population-based studies, which assessed the prevalence of latent autoimmune diabetes in adults in China and used a radioimmunoassay to test for glutamic acid decarboxylase autoantibodies. Subgroup analyses were done by study design, sex, and types of autoantibodies. Random-effects meta-analysis was used to pool the prevalence rate with 95% CIs. Ethical approval was granted by the ethical committee of our hospital This study was registered at PROSPERO, number CRD42016040163. Findings 12 studies with a total of 21 576 individuals were included. There were three population-based studies and nine hospital-based studies recruiting patients with newly diagnosed types 2 diabetes. The meta-analysis of 12 studies showed that the prevalence of latent autoimmune diabetes in adults in Chinese patients with type 2 diabetes was 7·4% (95% CI 6·5–8·5; 21 576 participants from 12 studies), which was similar to that in white populations (6·8%, 5·6–8·3; 28 415 participants from 15 studies). The prevalence of latent autoimmune diabetes in adults from the population-based studies was 6·7% (95% CI 5·4–8·3; 12 144 participants from three studies) and the prevalence of latent autoimmune diabetes in adults from hospital-based studies was 7·8% (6·9–8·8; 9432 participants from nine studies). The prevalence of latent autoimmune diabetes in adults in men was 7·9% (95% CI 6·2–10·0; 10 947 participants from ten studies) and in women was 7·0% (5·7–8·5; 9440 participants from ten studies). Subgroup analysis by types of autoantibodies suggested that glutamic acid decarboxylase autoantibodies was the highest prevalence (5·9%, 95% CI 5·2–6·8; 24 068 participants from 12 studies), followed by islet cell antibodies (2·4%, 1·5–3·8; 678 participants from two studies), insulin autoantibodies (2·1%, 1·4–3·2; 6559 participants from six studies), zinc transporter type 8 antibodies (1·7%, 1·5–2·1; 7059 participants from two studies), and protein tyrosine phosphatase-like IA-2 autoantibodies (1·7%, 1·2–2·4; 16 748 participants from 5 studies). The prevalence of latent autoimmune diabetes in adults diagnosed by non-glutamic acid decarboxylase autoantibodies in China was 1·7% (95% CI 1·0–2·8; 18 671 participants from eight studies). Interpretation Our finding provides evidence for a high prevalence of latent autoimmune diabetes in adults in China. Additionally, screening of latent autoimmune diabetes in adults with multiple diabetes-associated autoantibodies is necessary in China. Funding None.