From the Guidelines
LADA diabetes should be treated with a patient-centered approach, considering the possibility of a slowly progressive form of type 1 diabetes, and measuring titres of islet-associated autoantibodies, such as anti-GAD, to aid in identification and encourage a more rapid transition to insulin therapy. When managing LADA diabetes, it is essential to consider the patient's individual needs and circumstances. According to the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) position statement 1, lean patients with LADA often present with mild hyperglycemia, which may be responsive to oral agents, but eventually develop more severe hyperglycemia and require intensive insulin regimens. Some key points to consider in the management of LADA diabetes include:
- Measuring titres of islet-associated autoantibodies, such as anti-GAD, to aid in identification and encourage a more rapid transition to insulin therapy 1
- Monitoring blood glucose regularly to adjust treatment as needed
- Considering lifestyle modifications, such as regular physical activity, balanced nutrition, and weight management, to help manage the condition
- Understanding that insulin needs will increase over time, unlike type 2 diabetes, where lifestyle changes may reduce medication requirements
- Early recognition of LADA is crucial because appropriate insulin therapy can help preserve remaining beta cell function and prevent complications.
From the Research
Definition and Diagnosis of LADA
- LADA (Latent Autoimmune Diabetes in Adults) is a form of diabetes that combines characteristics of both type 1 and type 2 diabetes 2, 3.
- Approximately 10% of individuals with type 2 diabetes-like symptoms actually have LADA, which is characterized by the presence of islet autoantibodies and a gradual progression to insulin dependence 2, 3.
- Diagnosis of LADA is crucial, as it has significant implications for treatment and disease management 2, 4.
Treatment of LADA
- The optimal treatment strategy for LADA is not well established, and current practices vary widely 3, 5.
- Early insulin therapy is often recommended to achieve good metabolic control and preserve β-cell function 2, 4.
- Sulfonylureas are generally not recommended, as they can accelerate β-cell exhaustion and worsen disease outcomes 2, 5.
- Metformin and newer oral hypoglycemic agents, such as GLP-1RA and DPP-4 inhibitors, may be used in combination with insulin to manage LADA 4.
Challenges and Future Directions
- There is a need for larger, randomized controlled trials to compare the efficacy of different treatment options for LADA 3, 4.
- Improved diagnostic approaches and biomarkers are necessary to identify LADA patients and initiate timely treatment 4, 6.
- Further research is required to understand the pathophysiology of LADA and develop effective therapeutic strategies to slow disease progression 3, 6.