Latent Autoimmune Diabetes of Adults (LADA)

Latent Autoimmune Diabetes of Adults (LADA) is a form of diabetes that shares characteristics of both type 1 and type 2 diabetes. It is often misdiagnosed as type 2 diabetes due to its onset in adulthood and its slow progression. LADA is characterized by the presence of autoimmune markers, such as autoantibodies, which are typically associated with type 1 diabetes.¹

The history of LADA dates back to the late 1970s when researchers first identified a group of individuals who were initially diagnosed with type 2 diabetes but later exhibited autoimmune markers.² This discovery led to the recognition of LADA as a distinct form of diabetes. Since then, numerous studies have been conducted to better understand the incidence and characteristics of LADA.

The incidence of LADA varies across different populations, but it is estimated to account for approximately 4-14% of all cases of diabetes in adults.³ LADA typically affects individuals over the age of 30, although it can occur at any age. It is more common in individuals who are lean or have a normal body mass index (BMI) compared to those with type 2 diabetes.⁴

Treatment

Pharmaceutical treatment for LADA is similar to that of type 1 diabetes. Since LADA is characterized by autoimmune destruction of pancreatic beta cells, individuals with LADA eventually require insulin therapy to manage their blood glucose levels. However, the progression to insulin dependence is usually slower in LADA compared to type 1 diabetes.²

In the early stages of LADA, oral antidiabetic medications, such as metformin or sulfonylureas, may be prescribed to help control blood sugar levels. However, as the disease progresses and beta cell function declines, insulin therapy becomes necessary. The specific insulin regimen and dosage vary depending on individual needs.⁴

It is important to accurately diagnose LADA to ensure appropriate treatment and management. This requires testing for autoimmune markers, such as islet cell antibodies (ICA), insulin autoantibodies (IAA), glutamic acid decarboxylase antibodies (GADA), and insulinoma-associated-2 autoantibodies (IA-2A).⁵ These tests, along with clinical evaluation, can help differentiate LADA from other forms of diabetes.

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Sources:

1. Pozzilli, et al., “Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement from an International Expert Panel” Diabetes, accessed June 5, 2024, https://diabetesjournals.org/diabetes/article/69/10/2037/16062/Management-of-Latent-Autoimmune-Diabetes-in-Adults.
2. Carlsson, Sopia, “Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes,” Frontiers in Physiology, accessed June 5, 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444059/.
3. Laugesen, et al., “Latent Autoimmune Diabetes of the Adult: Current Knowledge and Uncertainty,” Diabetes Medicine, accessed June 5, 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676295/.
4. O’Neal, et al., “Recognizing and Appropriately Treating Latent Autoimmune Diabetes in Adults,” Diabetes Spectrum, accessed June 5, 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111528/.
5. Winter, et al., “Immunological Markers in the Diagnosis and Prediction of Autoimmune Type 1a Diabetes,” Clinical Diabetes, accessed June 5, 2024, https://diabetesjournals.org/clinical/article/20/4/183/744/Immunological-Markers-in-the-Diagnosis-and.