Comparison of Clinical and Laboratory Characteristics Between Adult-Onset Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Rosário, Pedro Weslley; Reis, Janice Sepúlveda; Amim, Ricardo; Fagundes, Tiago Alvarenga; Calsolari, Maria Regina; Silva, Saulo Cavalcanti; Purisch, Saulo

doi:10.2337/diacare.28.7.1803

Cited by 20 publications

(14 citation statements)

References 14 publications

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“…Although the onset of LADA occurs in many cases between 25 and 35 years (2), previous investigations (1,(3)(4)(5)7,12) have established a limit of 35 years as done in the present study.…”

Section: Methodsmentioning

confidence: 81%

“…According to another study that defined the cut-off based on the stratification of GADA titers (4), we also established the cutoff (17.2 U/ml) as the value corresponding to the median GADA titers at the time of diagnosis, which showed no normal distribution in the LADA group. Patients with type 1 diabetes (requiring insulin immediately after diagnosis) (1,3,8,12) were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

Rosário

Reis

Fagundes

et al. 2007

Arq Bras Endocrinol Metab

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Objective: To determine the clinical and laboratory parameters and the progression to insulin requirement in two groups of LADA patients separated according to GADA titers, and to evaluate the benefit of early insulinization in patients at high risk of premature beta-cell failure (high GADA titers). Methods: Among the diabetic adults seen at our service and screened for GADA at diagnosis, 54 were diagnosed with LADA and classified as having low (> 1 U/ml and < 17.2 U/ml) or high (> 17.2 U/ml) GADA titers. Fifty-four patients with type 2 diabetes (GADA-) were selected for comparison. In addition, 24 patients who had GADA titers > 20 U/ml and who were not initially insulinized were compared to 16 patients who were insulinized at diagnosis. Results: Insulin resistance was higher in the GADA-group, followed by patients with low GADA titers. BMI and the frequency of arterial hypertension, elevated triglycerides and reduced HDL cholesterol were lower in the high GADA+ group, with no difference between the GADA-or low GADA+ groups. The high GADA+ group showed a greater reduction and lower levels of C-peptide and required insulin earlier during follow-up. Patients with GADA titers > 20 U/ml and insulinized early presented no significant variation in C-peptide levels, had better glycemic control and required a lower insulin dose than patients who were insulinized later. Conclusion: We agree that patients with LADA should be differentiated on the basis of GADA titers and that patients with GADA titers > 20 U/ml benefit from early insulinization.

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“…Although the onset of LADA occurs in many cases between 25 and 35 years (2), previous investigations (1,(3)(4)(5)7,12) have established a limit of 35 years as done in the present study.…”

Section: Methodsmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

Rosário

Reis

Fagundes

et al. 2007

Arq Bras Endocrinol Metab

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“…LADA patients, in comparison with type 1 diabetes, have higher insulin levels [54]. It follows that LADA, compared to type 1 diabetes and KPD, initially has either higher insulin secretory capacity or higher insulin resistance.…”

Section: Insulin Secretion and Sensitivitymentioning

confidence: 89%

Diabetes classification: grey zones, sound and smoke: Action LADA 1

Leslie

Kolb

Schloot

et al. 2008

Diabetes Metabolism Res

123

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Diseases gain identity from clinical phenotype as well as genetic and environmental aetiology. The definition of type 1 diabetes is clinically exclusive, comprising patients who are considered insulin dependent at diagnosis, whilst the definition of type 2 diabetes is inclusive, only excluding those who are initially insulin dependent. Ketosis-prone diabetes (KPD) and latent autoimmune diabetes in adults (LADA) are each exclusive forms of diabetes which are, at least initially, clinically distinct from type 2 diabetes and type 1 diabetes, and each have a different natural history from these major types of diabetes.KPD can be diagnosed unequivocally as diabetes presenting with the categorical clinical feature, ketoacidosis. In contrast, LADA can be diagnosed by the co-occurrence of three traits, not one of which is categorical or exclusive to the condition: adult-onset non-insulin-requiring diabetes, an islet autoantibody such as glutamic acid decarboxylase autoantibodies (GADA) or cytoplasmic islet cell autoantibodies (ICA), and no need for insulin treatment for several months post-diagnosis. But while some would split diabetes into distinct subtypes, there is a strong case that these subtypes form a continuum of varying severity of immune and metabolic dysfunction modified by genetic and non-genetic factors. This article discusses the nature of disease classification in general, and KPD and LADA in particular, emphasizing the potential value and pitfalls in classifying diabetes and suggesting a need for more research in this area.

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“…There are only two previous studies comparing LADA with type 1 diabetes, each suggesting a tendency for LADA to have more features of the metabolic syndrome, but control subjects were not included; each study was very small with a combined total of 94 patients with LADA and 112 type 1 diabetic patients, and one of them used highly selected patients with LADA (9,21). Large studies of type 1 diabetes have identified a prevalence of metabolic syndrome of 39% in Finnish patients, which was approximately three times the separately observed prevalence in nondiabetic Finnish subjects (22) and higher than the frequency in American patients with type 1 diabetes (22%) (23).…”

Section: Statistical Analysesmentioning

confidence: 99%

Metabolic Syndrome and Autoimmune Diabetes: Action LADA 3

Hawa

Thivolet²,

Mauricio³

et al. 2009

Diabetes Care

116

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OBJECTIVE -The purpose of this study was to estimate whether prevalence of metabolic syndrome in adult European diabetic patients is associated with type of diabetes.RESEARCH DESIGN AND METHODS -A consecutive series of patients attending hospital-based diabetes clinics were assessed for the frequency of metabolic syndrome and compared with population-based control subjects as part of the Action LADA study. In total, 2,011 subjects (aged 30 -70 years) were studied, including 1,247 patients with recent-onset type 2 diabetes without glutamic acid decarboxylase autoantibodies (GADAs), 117 non-insulinrequiring patients with GADAs who had not received insulin therapy for at least 6 months after diagnosis (designated latent autoimmune diabetes of adults [LADA]), 288 type 1 diabetic patients, and 359 normal subjects.RESULTS -Frequency of metabolic syndrome was significantly different in patients with type 1 diabetes (31.9%) and LADA (41.9%) (P ϭ 0.015) and in both conditions was less frequent than in type 2 diabetic patients (88.8%) (P Ͻ 0.0001 for each). Eliminating glucose as a variable, the prevalence of metabolic syndrome was similar in patients with autoimmune diabetes (type 1 diabetes and/or LADA) (17.3%) and control subjects (23.7%) but remained more common in type 2 diabetic patients (47.8%) (P ϭ 0.001 for all groups). In both type 1 diabetic patients and those with LADA, individual components of metabolic syndrome were similar but less common than in type 2 diabetic patients (P Ͻ 0.0001 for each).CONCLUSIONS -The prevalence of metabolic syndrome is significantly higher in type 2 diabetic patients than in patients with LADA or adults with type 1 diabetes. Excluding glucose as a variable, metabolic syndrome is not more prevalent in patients with autoimmune diabetes than in control subjects. Metabolic syndrome is not a characteristic of autoimmune diabetes.

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Comparison of Clinical and Laboratory Characteristics Between Adult-Onset Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Cited by 20 publications

References 14 publications

Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

Latent autoimmune diabetes in adults (LADA): usefulness of anti-GAD antibody titers and benefit of early insulinization

Diabetes classification: grey zones, sound and smoke: Action LADA 1

Metabolic Syndrome and Autoimmune Diabetes: Action LADA 3

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