Authors' objectives:

The aim of this review was to determine the role of autoantibody tests for autoimmune diseases in children with newly diagnosed type 1 diabetes mellitus.

Authors' results and conclusions: Seventy-six studies were included. Many studies were of poor quality on several indicators, particularly concerning the description of the study design and patient selection. Only 18 studies reported the method of patient selection. All but four studies were in symptomatic, not screening, populations. All antibody tests showed reasonably good diagnostic test accuracy, with the area under the curve >0.9 for all tests. IgA EMA, IgA ARA and IgA TTG stood out as particularly good tests, followed by IgA AGA and then IgG AGA. IgA EMA tests have the highest pooled positive likelihood ratio and lowest negative likelihood ratio and IgA TTG tests have high positive likelihood ratio compared with AGA tests. Studies reported variable measures of test accuracy, which may be due to aspects of study quality, differences in the tests (including manufacturers and substrates) and their execution in the laboratories, different populations and reference standards.

Authors' recommendations: In terms of test accuracy in testing for coeliac disease, IgA EMA (using indirect immunofluorescence) is the most accurate test. If an ELISA test was required, which may be more suitable for screening purposes as it can be semi-automated, testing for IgA TTG is likely to be most accurate. The decision-analytic model shows that the most accurate tests combined with confirmatory biopsy are the most cost-effective, whilst combinations of tests add little or no further value. There is limited information regarding test accuracy in populations with diabetes, and there is some uncertainty over whether the test characteristics would remain the same, particularly as there may be a proportion of silent disease. Further research is required regarding the role of screening in silent coeliac disease and regarding long-term outcomes and complications of untreated coeliac disease.

Authors' methods: Systematic review, Survey

Project Status: Completed

URL for project: http://www.hta.ac.uk/1319

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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