Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management

Abstract

Latent autoimmune diabetes in adults (LADA) is a heterogeneous disease characterized by a less intensive autoimmune process and a broad clinical phenotype compared to classical type 1 diabetes mellitus (T1DM), sharing features with both type 2 diabetes mellitus (T2DM) and T1DM. Since patients affected by LADA are initially insulin independent and recognizable only by testing for islet-cell autoantibodies, it could be difficult to identify LADA in clinical setting and a high misdiagnosis rate still remains among patients with T2DM. Ideally, islet-cell autoantibodies screening should be performed in subjects with newly diagnosed T2DM, ensuring a closer monitoring of those resulted positive and avoiding treatment of hyperglycaemia which might increase the rate of β-cells loss. Thus, since the autoimmune process in LADA seems to be slower than in classical T1DM, there is a wider window for new therapeutic interventions that may slow down β-cell failure. This review summarizes the current understanding of LADA, by evaluating data from most recent studies, the actual gaps in diagnosis and management. Finally, we critically highlight and discuss novel findings and future perspectives on the therapeutic approach in LADA.

Keywords: Diabetes mellitus, type 1; Hypoglycemic agents; Insulin; Insulin resistance; Insulin-secreting cells; Latent autoimmune diabetes in adults.

Fig. 1. The heterogeneity of diabetes, with latent autoimmune diabetes in adults (LADA) that shares halfway clinical, genetic and immunological features between type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM). GADA, glutamic acid decarboxylase autoantibody; HLA, human leukocyte antigen.

Fig. 2. Proposal of algorithm for diagnosis latent autoimmune diabetes in adults (LADA). BMI, body mass index; GADA, glutamic acid decarboxylase autoantibody; T2DM, type 2 diabetes mellitus.