21 hours ago Latent Autoimmune Diabetes in Adults (LADA) is often misdiagnosed because it lacks both awareness and standardized diagnostic criteria. A 30-year-old patient with high blood glucose, … >> Go To The Portal
Such a slowly evolving form of autoimmune diabetes, described as latent autoimmune diabetes of adults (LADA), accounts for 2–12% of all patients with adult-onset diabetes, though they show considerable variability according to their demographics and mode of ascertainment.
Brophy S, Davies H, Mannan S, Brunt H, Williams R. Interventions for latent autoimmune diabetes (LADA) in adults. Cochrane Database Syst Rev. 2011 Sep 07; (9):CD006165. [ PMC free article 37.
Data reported in LADA show that this is the most frequent form of adult-onset autoimmune diabetes and may account for 2% to 12% of all cases of diabetes in the adult population.
Adult-onset diabetes (>30 years at diagnosis), presence of diabetes-associated autoantibodies, and absence of insulin requirement for at least 6 months after diagnosis are the key current diagnostic criteria for LADA ( Table 1 ).
Data obtained from all major studies including the UK Prospective Diabetes Study (UKPDS) ( 4) and the Botnia study ( 5) show that the autoantibody frequency (GADA) in patients diagnosed with T2D is higher in younger patients compared with older patients (e.g., in UKPDS from 34% when aged 25–34 years to 7% in older patients aged 55–65 years).
By definition, LADA patients have functioning β-cells at diagnosis indicating that it is imperative to implement therapeutic strategies targeted to improve metabolic control but also to preserve the insulin-secreting capacity ( 53 ).
The panel agreed that to effectively identify patients affected by LADA, all newly diagnosed T2D patients should be screened for GADA positivity (immune marker with the highest sensitivity) to allow for a rapid diagnosis and implementation of an appropriate therapy and follow-up of progressing β-cell failure.
Diabetes that develops in human immunodeficiency virus-infected individuals is typically classified as type 2 diabetes mellitus. Although less commonly reported, it has been shown that autoimmune diabetes can also develop in this population.
A 68-year-old, African American man with human immunodeficiency virus had a nadir CD4 count of 2 cells/μL, which improved with anti-retroviral therapy. He was subsequently diagnosed with type 2 diabetes mellitus but developed worsening glycemic control. Further investigation demonstrated an elevated glutamic acid decarboxylase antibody level >250 IU/mL and a declining C peptide level from 1.82 ng/mL to 0.56 ng/mL. He was ultimately diagnosed with autoimmune diabetes that was treated with insulin glargine and insulin aspart with improvement in his glycemic control.
Latent autoimmune diabetes of adults (LADA) is a type of autoimmune diabetes that begins in adulthood (usually after the age of 35 years); its main feature is the presence of diabetes-associated autoantibodies (most often autoantibody against glutamic acid decarboxylase), which leads to progressive destruction of the islets of Langerhans.
Diabetes mellitus (DM) remains one of the commonest chronic diseases worldwide, and it is among the top 10 causes of death in adults [1]. Although the classification of DM has been expanding, traditionally, a newly diagnosed patient receives a diagnosis of either type 1 or 2 diabetes based on the clinical scenario.
A 71-year-old Caucasian male was diagnosed with type 2 diabetes one year ago, and he was started on metformin, with the later addition of vildagliptin and acarbose. Despite dietary measures and oral antidiabetic therapy, the patient remained poorly controlled, and he was referred to an internal medicine diabetic clinic.
LADA, also called type 1.5 diabetes, is the most common form of autoimmune diabetes diagnosed in adults, and approximately 5-12% of cases in European populations with apparent type 2 diabetes are, in fact, misdiagnosed LADA patients [7]. This disease is part of a continuum between type 1 and type 2 diabetes.
This case highlights the importance of the clinical recognition of LADA and the implementation of screening diagnostic tests, emphasizing that all patients who do not fit the typical type 2 DM profile should be further investigated.