From the Guidelines
I would suspect latent autoimmune diabetes in adults (LADA) in patients who present with features that fall between type 1 and type 2 diabetes, particularly those with a lower BMI, absence of metabolic syndrome features, and positive autoantibodies, as indicated by the most recent guidelines 1. When evaluating patients for LADA, it is essential to consider the following key clinical indicators:
- Lower BMI than typical type 2 diabetics
- Absence of metabolic syndrome features
- Personal or family history of autoimmune conditions
- Rapid deterioration of beta cell function Laboratory findings that support LADA include:
- Positive autoantibodies (particularly GAD65 antibodies) 1
- Lower C-peptide levels indicating diminished insulin production
- Absence of insulin resistance markers According to the latest guidelines, measuring titres of islet-associated autoantibodies, such as anti-GAD, may aid in the identification of LADA 1. The 2025 standards of care in diabetes also provide a flowchart for investigating suspected type 1 diabetes in newly diagnosed adults, which includes testing for islet autoantibodies and C-peptide levels 1. It is crucial to note that LADA is a slowly progressing form of type 1 diabetes, where the autoimmune destruction of pancreatic beta cells occurs more gradually than in childhood-onset type 1 diabetes. Early identification is vital because these patients will eventually require insulin therapy, and early insulin treatment may help preserve remaining beta cell function longer than oral agents alone 1.
From the Research
Clinical Presentation of Latent Autoimmune Diabetes in Adults
The clinical presentation of Latent Autoimmune Diabetes in Adults (LADA) can be similar to that of Type 2 Diabetes Mellitus (T2DM), making it challenging to diagnose 2, 3. Some key features that may suggest LADA include:
- Slow progression to insulin dependence
- Presence of islet-cell autoantibodies
- Initial insulin independence
- Broad clinical phenotype compared to classical Type 1 Diabetes Mellitus (T1DM)
Diagnostic Considerations
Diagnosing LADA can be difficult due to its similarity to T2DM, and a high misdiagnosis rate still remains among patients with T2DM 2. Some diagnostic biomarkers that can be used to identify LADA include:
- C-peptide levels
- Autoantibodies against β-cells 4
- Islet-cell autoantibodies screening, which should be performed in subjects with newly diagnosed T2DM 2
Treatment Implications
The optimal treatment of LADA is not established, but early insulin therapy can help achieve good metabolic control and better long-term outcomes by preserving β-cells and endogenous C-peptide secretion 5. Other treatment approaches that may be considered include: