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.

The Differential Expression of Long Noncoding RNAs in Type 2 Diabetes Mellitus and Latent Autoimmune Diabetes in Adults

“…e autoimmune process of LADA is slower than that of the classical type 1 diabetes mellitus (T1DM) and new therapeutic interventions might cause a delay in ß cell failure. Early diagnosis is thus crucial for the treatment of LADA [1]. Long noncoding RNAs (lncRNAs) are a type of ncRNAs with transcripts exceeding 200 nucleotides in length [2].…”

Glucose variability for a short period of low carbohydrate diet in diabetic patients with possible latent autoimmune diabetes in adults

“…Thus, the value of day 4 would be calculated to be higher in Group-1 compared with Group-2. These results suggest that cases in Group-1 may have less ability of insulin secretion than that in Group-2 [34].…”

“…It has been known that patients with LADA may show slower decreasing pancreas function for years. Moreover, it is possible that they may have a lower reserve ability to secrete insulin in a shorter period [34]. This possible pathophysiology could be raised by our current research protocol.…”

Peer Review #1 of "A convenient diagnostic tool for discriminating adult-onset glutamic acid decarboxylase antibody-positive autoimmune diabetes from type 2 diabetes: a retrospective study (v0.1)"

“…In the absence of autoantibody testing, it is not uncommon for it to be diagnosed and treated as type 2 diabetes (T2DM) [1,2]. The lack of optimal treatment can result in deterioration of the autoimmune process, the acceleration of beta cell loss, faster progression to insulin dependence, and an increased risk of complications [2,3].…”

“…Islet cell cytoplasmic autoantibodies (ICA), insulin autoantibodies (IAA), glutamic acid decarboxylase antibodies (GADA), tyrosine phosphatase IA-2 autoantibodies (IA-2A), and zinc transporter 8 autoantibodies (ZnT8A) are the major autoantibodies of clinical and research interest [1,4]. The reported incidence of T1DM-related autoantibodies in adult-onset diabetes is approximately 3%-12%, with variations between countries and ethnicities [1][2][3]. GADA are persistent in patients with long-standing diabetes and is not influenced by the age at disease onset.…”