From the Guidelines
Maturity-Onset Diabetes of the Young (MODY) and Latent Autoimmune Diabetes in Adults (LADA) are two distinct forms of diabetes with different underlying pathophysiologies and clinical characteristics.
Key Differences
- Age of onset: MODY typically presents at a young age, often before 25 years, whereas LADA presents in adulthood, usually after 30 years of age 1.
- Autoimmunity: LADA is characterized by the presence of autoantibodies, such as GADA, which predict insulin dependency, whereas MODY is not associated with autoimmunity 1.
- Insulin secretion: MODY is caused by impaired insulin secretion due to monogenic defects, whereas LADA is characterized by autoimmune destruction of pancreatic beta cells, leading to progressive insulin deficiency 1.
- Treatment: MODY is often treated with sulfonylureas or other oral hypoglycemic agents, whereas LADA typically requires insulin therapy due to progressive insulin deficiency 1.
- Genetic basis: MODY is caused by specific genetic mutations, such as GCK, HNF1A, and HNF4A, whereas LADA is not associated with a specific genetic mutation, but rather with autoimmune destruction of pancreatic beta cells 1.
Clinical Implications
- Diagnosis: A diagnosis of MODY or LADA has important implications for treatment and management, as well as for genetic counseling and family screening 1.
- Treatment approach: Understanding the underlying pathophysiology of MODY and LADA is crucial for selecting the most effective treatment approach, which can improve glycemic control and prevent long-term complications 1.
- Family screening: Identification of MODY or LADA in an individual can lead to screening of family members, which can help identify other affected individuals and allow for early intervention and treatment 1.
From the Research
Difference between MODY and LADA
- MODY (Maturity-Onset Diabetes of the Young) is a group of monogenic diseases characterized by autosomal dominant inheritance of a non-insulin-dependent form of diabetes that classically manifests in adolescence or in young adults under 25 years of age 2, 3.
- LADA (Latent Autoimmune Diabetes in Adults) is a form of autoimmune diabetes that is distinct from MODY, and is characterized by the presence of autoimmune antibodies and a gradual onset of insulin deficiency 4.
- The key difference between MODY and LADA is the presence of autoimmune antibodies in LADA, which is not found in MODY 4.
- MODY is often misdiagnosed as type 1 or type 2 diabetes, while LADA is often misdiagnosed as type 2 diabetes 2, 3, 4.
Clinical Characteristics
- MODY is characterized by a strong family history of diabetes, onset at a young age, and absence of pancreatic islets autoimmunity 2, 3, 5, 6.
- LADA is characterized by the presence of autoimmune antibodies, such as GAD antibodies, and a gradual onset of insulin deficiency 4.
- Patients with MODY have preserved pancreatic beta-cell function, while patients with LADA have a progressive decline in beta-cell function 4, 6.
Treatment
- The treatment of MODY depends on the subtype, with some subtypes requiring lifestyle modification and others requiring pharmacologic therapy, such as sulfonylureas 2, 3, 5, 6.
- LADA is typically treated with insulin therapy, although some patients may be managed with oral hypoglycemic agents initially 4.
- In cases where MODY and LADA coexist, the treatment approach should take into account the characteristics of both conditions, and may require individualized therapy to achieve optimal glycemic control 4.