Latent autoimmune diabetes of the adult, also known as LADA, is a type of diabetes that is characterized by a slow onset and the presence of autoantibodies associated with type 1 diabetes. LADA is sometimes referred to as type 1.5 diabetes, as it shares features of both type 1 and type 2 diabetes. In this article, we will explore the features of LADA, its diagnosis, treatment, and prognosis.
LADA is a form of autoimmune diabetes, which means that the body’s immune system mistakenly attacks the cells in the pancreas that produce insulin. This results in a gradual loss of insulin-producing cells, leading to a decrease in insulin production over time. However, unlike type 1 diabetes, which typically develops in childhood or adolescence, LADA has a later onset, usually between the ages of 30 and 50.
One of the defining features of LADA is the presence of autoantibodies associated with type 1 diabetes. These autoantibodies, which include glutamic acid decarboxylase (GAD) antibodies and insulinoma-associated antigen 2 (IA-2) antibodies, are markers of an autoimmune response against the beta cells in the pancreas. In contrast, type 2 diabetes is not associated with the presence of these autoantibodies.
LADA is often misdiagnosed as type 2 diabetes, as it shares many of the same symptoms and risk factors. These include:
- Frequent urination
- Increased thirst
- Fatigue
- Blurred vision
- Slow-healing cuts or bruises
- Family history of diabetes
- Obesity
- Sedentary lifestyle
- Poor diet
However, LADA tends to progress more rapidly than type 2 diabetes and may require insulin therapy earlier in the disease course.
Diagnosis of LADA involves a combination of clinical and laboratory tests. A doctor may suspect LADA if a patient has a family history of type 1 diabetes, is under the age of 50 at diagnosis, or has a lean body mass. Blood tests can then be performed to detect the presence of autoantibodies associated with type 1 diabetes. A low C-peptide level, which is a marker of insulin production, may also suggest a diagnosis of LADA.
Treatment for LADA is similar to that for type 1 diabetes, in that insulin therapy is typically required to manage blood glucose levels. However, the initial management of LADA may involve oral medications, such as metformin or sulfonylureas, to stimulate insulin production. These medications may be effective in the early stages of LADA, but as insulin production declines, insulin therapy becomes necessary.
There is some evidence to suggest that early insulin therapy may improve outcomes in LADA. A study published in Diabetes Care found that patients with LADA who received early insulin therapy had better glycemic control and a lower risk of complications than those who received oral medications alone.
In addition to insulin therapy, lifestyle changes can also be effective in managing LADA. These include:
- Eating a healthy diet that is low in carbohydrates and high in fiber
- Engaging in regular physical activity, such as walking, cycling, or swimming
- Maintaining a healthy weight
- Avoiding smoking and excessive alcohol consumption
Prognosis for LADA varies depending on the stage of the disease at diagnosis and the individual’s response to treatment. Some patients with LADA may have a slower disease progression and be able to maintain good glycemic control for many years without insulin therapy. Others may require insulin therapy early in the disease course and have a higher risk of complications.
Overall, LADA is a distinct form of diabetes that is characterized by a slow onset, the presence of autoantibodies associated with type 1 diabetes,