From the Guidelines
Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is a form of diabetes that shares characteristics of both Type 1 and Type 2 diabetes, where the body's immune system gradually destroys insulin-producing beta cells in the pancreas, similar to Type 1 diabetes, but with a slower progression typically occurring in adults over age 30. This condition is characterized by the presence of islet-associated autoantibodies, such as anti-GAD, which can aid in the identification of LADA patients 1. According to the most recent guidelines, approximately 5% to 10% of White adults who present with a type 2 diabetes phenotype have islet autoantibodies, particularly GADA, which predict insulin dependency 2.
Key Characteristics of LADA
- Autoimmune condition with gradual destruction of insulin-producing beta cells
- Slower progression compared to Type 1 diabetes
- Typically occurs in adults over age 30
- Presence of islet-associated autoantibodies, such as anti-GAD
- Initial response to oral medications, diet, and exercise, but eventual requirement for insulin therapy
Diagnosis and Treatment
- Diagnosed through antibody testing, particularly GAD (glutamic acid decarboxylase) antibodies
- Treatment typically begins with lifestyle modifications and may include oral medications
- Insulin therapy becomes necessary sooner than in typical Type 2 diabetes, usually within months to years after diagnosis
- Early identification of LADA is important to preserve remaining beta cell function and prevent complications associated with poor glucose control 2.
From the Research
Definition and Characteristics of Type 1.5 Diabetes
- Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is a form of diabetes that combines features of both type 1 and type 2 diabetes 3.
- It is characterized by a slow autoimmune destruction of pancreatic beta cells, leading to insulin deficiency over time 4.
- LADA is often misdiagnosed as type 2 diabetes due to its initial presentation with insulin independence, but it can be identified by the presence of islet-cell autoantibodies 3.
Clinical Implications and Management
- The optimal treatment for LADA is not established, but early insulin therapy may help achieve good metabolic control and preserve beta-cell function 5.
- Sulfonylureas are generally not recommended as a first-line treatment for LADA, as they may accelerate beta-cell failure and lead to earlier insulin dependence 6, 7.
- Other treatment options, such as metformin, glitazones, and exenatide, may be considered, but their effectiveness and safety in LADA patients require further study 5.
Pathogenesis and Immunotherapy
- LADA is characterized by a complex interplay between adaptive and innate immunity, as well as the intestinal microbiota, which contributes to the autoimmune destruction of pancreatic beta cells 4.
- Understanding the immunopathogenesis of LADA is crucial for the development of effective prevention and treatment strategies, including immunomodulators and therapies targeting the gut microbiota 4.
- Further research is needed to explore the potential of immunotherapy and other interventions to halt or delay the progression of autoimmunity in LADA patients 4.