14th September 2024

Latent autoimmune diabetes of adults

LADA can be thought of as a slowly progressive variant of Type 1 Diabetes Mellitus (T1DM). It actually borrows pathophysiology from T1DM (it is an autoimmune condition and the same autoantibodies are present), and T2DM (there is some degree of insulin resistance). A diagnosis is likely if a patient fulfils the following three criteria:

1. They are above 35 years old
2. There are antibodies present (ICA, GAD, Ia-2, ZnT8)
3. They remain insulin independent for at least 6 months from initial diagnosis.

C peptide can be helpful, as endogenous insulin production won’t initially be as low as in T1DM, so there will be residual C peptide production in the presence of autoantibodies. Insulin is the main therapy, but oral agents can also be used as for T2DM.

References

• Rajkumar V, Levine SN. Latent Autoimmune Diabetes. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557897/
• Fourlanos, S., Dotta, F., Greenbaum, C.J. et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia 48, 2206–2212 (2005). https://doi.org/10.1007/s00125-005-1960-7