Characteristics and Prevalence of Latent Autoimmune Diabetes in Adults (LADA)

Abstract

Diabetes, one of the most commonly seen metabolic disorders, is affecting a major area of population in many developing as well as most of the developed countries and is becoming an alarming concern for the rising cost of the healthcare system. Latent Autoimmune Diabetes in Adults (LADA) is a form of diabetes which is less recognized and underdiagnosed type of diabetes which appears to have characteristics of both type 1 (autoimmune in nature) and type 2 diabetes (adult age at onset and initial response to oral hypoglycemic agents). An epidemiological study was carried out on 500 patients in the western region of India. Various parameters such as age at onset, duration of diabetes, gender, basal metabolic index (BMI), type of diabetes, family history, HbA1c levels, cholesterol levels, and current treatment regimen were evaluated and correlated with type 1 and type 2 diabetes. Moreover, diagnostic markers for LADA, namely, GAD autoantibodies and C-peptide levels, were determined for 80 patients selected from the epidemiological study. Some of the results obtained were found to be consistent with the literature whereas some results were found to be contradictory to the existing data.

Figure 1

Prevalence of different types of diabetes in males and females. Black circle: prevalence pattern significantly different in type 1 diabetes as compared to type 2 diabetes (P < 0.01). Black square: prevalence pattern significantly different in LADA as compared to type 1 diabetes (P < 0.01).

Figure 2

Average age at onset of different types of diabetes. Black circle: significantly lower age of onset in type 1 diabetes compared to type 2 diabetes (P < 0.001) and undiagnosed patients (P < 0.001).Black square: significantly higher age of onset in type 2 diabetes compared to undiagnosed patients (P < 0.001). Black triangle: significantly lower age of onset in LADA compared to type 2 diabetes (P < 0.001) and higher than Type 1 (P < 0.001).

Figure 3

Family history pattern in LADA. F-Father, M-Mother, MF-Mother and Father, B/S- Brother or Sister.

Figure 4

BMI values in different types of diabetes. U-Underweight, H-Healthy, O-Overweight, Ob-Obese, Vob-Very Obese.

Figure 5

Treatment regimen for different types of diabetes. I-Insulins, OHA-Oral Hypoglycemic Agents.

Figure 6

Mean C-peptide levels in different types of diabetes. Black circle: significantly lower C-peptide levels in type 1 diabetes as compared to type 2 diabetes (P < 0.05). Black square: significantly higher C-peptide levels in type 2 diabetes as compared to type 1 diabetes and LADA (P < 0.05). Black triangle: significantly lower C-peptide levels in LADA as compared to type 2 diabetes (P < 0.05).

Figure 7

Mean GAD autoantibodies levels in different types of diabetes. Black square: significantly lower GAD autoantibodies levels in type 2 diabetes as compared to type 1 diabetes, LADA, and undiagnosed patients (P < 0.05). Black circle: significantly higher GAD autoantibodies levels in LADA as compared to type 1 diabetes and type 2 diabetes (P < 0.05). Black triangle: significantly higher GAD autoantibodies levels in undiagnosed patients as compared to type 1 diabetes (P < 0.01) and type 2 diabetes (P < 0.05). (+) indicates presence of GAD auto antibodies. (−) indicates absence of GAD auto antibodies.