Slowly evolving immune-mediated diabetes, or Latent Autoimmune Diabetes in Adults (LADA), is a form of diabetes that exhibits clinical features similar to both Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D). It is an autoimmune form of diabetes, similar to T1D, but patients with LADA often show insulin resistance, similar to T2D, and share some risk factors for the disease with T2D. Studies have shown that LADA patients have certain types of antibodies against the insulin-producing cells, and that these cells stop producing insulin more slowly than in T1D patients.

LADA appears to share genetic risk factors with both T1D and T2D but is genetically distinct from both. Within the LADA patient group, a genetic and phenotypic heterogeneity has been observed with varying degrees of insulin resistance and autoimmunity. With the knowledge we have today, LADA can thus be described as a hybrid form of T1D and T2D, showing phenotypic and genotypic similarities with both, as well as variation within LADA regarding the degree of autoimmunity and insulin resistance. The concept of LADA was first introduced in 1993, though The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus does not recognize the term, instead including it under the standard definition of diabetes mellitus type 1.

The symptoms of latent autoimmune diabetes in adults are similar to those of other forms of diabetes: polydipsia (excessive thirst and drinking), polyuria (excessive urination), and often blurred vision. Compared to juvenile type 1 diabetes, the symptoms develop comparatively slowly, over a period of at least six months. A fasting blood sugar level of ≥ 7.0 mmol/L is used in the general diagnosis of diabetes. There are no clear guidelines for the diagnosis of LADA, but the criteria often used are that the patient should develop the disease in adulthood, not need insulin treatment for the first 6 months after diagnosis and have autoantibodies in the blood. Glutamic Acid Decarboxylase Autoantibody (GADA), Islet Cell Autoantibody (ICA), Insulinoma-Associated (IA-2) autoantibody, and Zinc Transporter autoantibody (ZnT8) testing should be performed in order to correctly diagnose diabetes. Persons with LADA typically have low, although sometimes moderate, levels of C-peptide as the disease progresses. Those with insulin resistance or type 2 diabetes are more likely to have high levels of C-peptide due to an over production of insulin.

Glutamic acid decarboxylase autoantibodies, islet cell autoantibodies, insulinoma-associated autoantibodies, and zinc transporter autoantibodies are all associated with LADA; GADAs are commonly found in cases of diabetes mellitus type 1. Since there is no regular autoantibody screening, patients with LADA are at risk of being diagnosed with type 2 diabetes, which makes it difficult to estimate the prevalence of LADA. Globally, it is estimated that about 8.5% of adults suffer from some form of diabetes and it is estimated that LADA accounts for about 3-12% of all adult diabetes cases. Estimates from 2015 are saying that there could be as many as 10–20% of people with diabetes having LADA.

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Regards,
Morgan E,
Editorial Manager,
Journal of Clinical Diabetes.

E-mail: clindiabetes@eclinicalsci.com