Description
Adult-onset autoimmune disease known as latent autoimmune diabetes of adults (LADA) does not require insulin for glycemic management during the first six months following diagnosis. Although LADA is frequently misdiagnosed as type 2 diabetes, it has genetic, immunologic, and metabolic characteristics with both types 1 and 2 diabetes mellitus (DM) (T2DM). Similar to type 2 diabetes, lifestyle modifications may halt the advancement of LADA, as the condition is caused by multiple unknown variables.
Résumé
- LADA, or Latent Autoimmune Diabetes in Adults, is often referred to as Type 1.5 diabetes due to its overlapping characteristics with Type 1 and Type 2 diabetes. It is characterized by hyperglycemia and requires careful differentiation from other diabetes types, as treatment plans differ significantly. The diagnosis hinges on factors like age of onset, C-peptide levels, autoimmunity markers, and family history.
- The key discovery relating to LADA was the presence of glutamic acid decarboxylase (GAD) antibodies, associated with severe insulin deficiency in patients initially diagnosed with Type 2 diabetes. This led to the understanding that LADA patients, previously treated as Type 2 diabetics, require a different management approach due to their autoimmune-driven insulin deficiency.
- Epidemiological studies globally estimate LADA prevalence between 2% and 12%. Indian studies show varying prevalence based on region and autoantibody type, with some reporting high rates of islet autoantibodies. Genetics also plays a role, with HLA genes being a major susceptibility locus, alongside other genes like CTLA4 and PTPN22.
- Diagnostic criteria emphasize age of onset (over 30 years), lack of initial insulin requirement (at least 6 months), and the presence of circulating islet cell antibodies. LADA shares the elevated cardiovascular risk found in both Type 1 and Type 2 diabetes, but differs in other clinical features like BMI, lipid profiles, and family history of autoimmune diseases.
- A key component of management is a diagnostic algorithm that starts with a clinical risk assessment considering factors such as age, BMI, and family history of autoimmune disease. Based on the presence of these factors, GAD antibody testing is performed, and C-peptide levels are measured to guide treatment decisions.
- Treatment depends on C-peptide levels. Low levels indicate significant insulin deficiency and necessitate insulin therapy. Higher levels may allow for oral antidiabetic medications, excluding sulfonylureas. The overall goal is to control hyperglycemia, preserve beta-cell function, and prevent diabetes complications through individualized treatment plans.
- Challenges in diagnosing LADA include the cost of GAD antibody testing and the need for strong clinical acumen to identify potential cases in resource-limited settings. Potential triggers for the autoimmune response include viral infections and imbalances in the immune system leading to the production of autoantibodies against pancreatic beta cells.
Exemple de certificat
À propos des intervenants
Dr. Surajeet Kumar Patra
Director and Consultant diabetologist at Dr. Surajeet Patra's Clinic in Bhubaneswar, Orissa
Divulgation financière
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