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

Abstract

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.

Clinical Evidence for the Earlier Initiation of Insulin Therapy in Type 2 Diabetes

“…65,66 Initiating therapy with insulin may therefore be particularly beneficial for those individuals with LADA who have high titers of glutamic acid decarboxylase antibody (>20 U/mL). 67 Third, as insulin treatment is known to have additional anti-inflammatory and antioxidant effects, which may contribute to protection against endothelial dysfunction and vascular disease, [15][16][17] early insulin treatment is particularly suitable for individuals already at high risk for vascular complications, such as those with hyperlipidemia, hypertension, or both. In individuals with protracted disease who remain inadequately controlled on a multitude of other antidiabetic drugs, careful introduction of insulin is required to avoid hypoglycemia.…”

Comparative study between two recombinant human NPH insulin formulations for the treatment of type 2 diabetes mellitus

“…2016;60/1 Recombinant human NPH insulin formulations for DM2 age was significantly different (p = 0.012), which rai ses questions about the inclusion of patients with latent autoimmune diabetes in adults (LADA) in group 1; however, this possibility is unlikely because all patients included in the study were antiGADnegative (14,15). Another factor to be considered relative to the variable age is that older patients usually have decreased renal function, which can affect clinical kinetics and respon se.…”

Association of polymorphism rs7903146 gene TCF7L2 with low concentrations of autoantibodies in latent autoimmune diabetes of adults (LADA)

“…Значе-ния GADA, ICA, IA-2A выше 20 Ед/мл расценивались как высокие [16,17]. Значения антител ZnT8 выше 30 Ед/мл (двукратное превышение референсных значе-ний) расценивались как высокие.…”