From the Guidelines
Treatment for latent autoimmune diabetes in adults (LADA) should prioritize early introduction of insulin therapy to preserve remaining beta cell function, alongside lifestyle modifications and potentially oral medications like metformin, with a focus on achieving tight blood glucose control to minimize morbidity and mortality. When managing LADA, it's crucial to consider the patient's lean body mass and the possibility of a slowly progressive form of type 1 diabetes, as noted in the position statement by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1. Key aspects of treatment include:
- Lifestyle modifications such as diet and exercise to manage hyperglycemia
- Oral medications like metformin, starting at a low dose (e.g., 500mg daily) and increasing as tolerated up to 1000-2000mg daily
- Early introduction of basal insulin (e.g., insulin glargine or insulin detemir) to preserve beta cell function, with initial doses often around 10 units daily and adjustments based on blood glucose readings
- Progression to multiple daily insulin injections with both basal and bolus insulin as the disease progresses, aiming for tight blood glucose control with fasting glucose targets of 80-130 mg/dL and post-meal readings below 180 mg/dL
- Regular blood glucose monitoring and A1C testing (every 3-6 months) to track long-term control, with targets typically below 7%
- Avoidance of sulfonylureas due to their potential to accelerate beta cell burnout, as suggested by the nature of LADA as a form of autoimmune diabetes 1.
From the Research
Treatment Options for Latent Autoimmune Diabetes in Adults
- The optimal treatment strategy for Latent Autoimmune Diabetes in Adults (LADA) is not established, and current practices are not well-elucidated compared to Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) 2.
- Early insulin treatment has been shown to lead to better preservation of metabolic control and is safe, although superior preservation of C-peptide could not be significantly demonstrated 3.
- Conventional treatment with diet and oral hypoglycemic agents (OHA) may lead to deterioration of metabolic control, and a significant proportion of patients may develop insulin dependency during follow-up 3.
- Sulfonylureas are generally avoided in LADA as they can exhaust β-cells, while glitazones and exenatide may have favorable outcomes 4.
- Metformin can be used with caution, and its effectiveness in LADA is still being studied 4.
Importance of Early Diagnosis and Treatment
- Early diagnosis of LADA is crucial, as it can help identify patients who are at high risk of progressing to insulin dependency 5, 4.
- Islet-cell autoantibody screening should be performed in subjects with newly diagnosed T2DM to ensure closer monitoring and avoid treatment that may increase the rate of β-cell loss 5.
- A high misdiagnosis rate still remains among patients with T2DM, and LADA clinical risk score can help identify adults at high risk who may benefit from antibody testing 4.
Preservation of β-Cell Function
- The decline in β-cell function progresses much faster in LADA than in T2D, presumably due to the ongoing autoimmune assault in LADA 2.
- Preserving β-cell function is essential to reduce the risk of diabetic complications, and early insulin treatment may help achieve this goal 3, 4.
- Further studies are needed to explore the best treatment strategy for LADA and to understand the role of GAD antibodies in its pathogenesis 6.