What is Latent Autoimmune Diabetes in Adults (LADA)?

From the Guidelines

Latent Autoimmune Diabetes in Adults (LADA) is a form of type 1 diabetes that progresses slowly, often requiring insulin therapy within a few years of diagnosis 1.

Key Characteristics of LADA

• It is characterized by the presence of autoantibodies, such as anti-GAD, and a gradual decline in insulin production 1.
• Initial treatment typically involves metformin, with a recommended dose of 500-1000 mg twice daily, and lifestyle modifications 1.
• As the disease progresses, insulin therapy may be initiated, starting with a basal insulin such as glargine or detemir, at a dose of 0.1-0.2 units/kg/day, with gradual titration to achieve optimal glycemic control 1.
• LADA is often diagnosed in adults who are initially thought to have type 2 diabetes, but who have a slower progression to insulin dependence and may have autoimmune markers such as anti-GAD antibodies 1.
• The presence of autoantibodies, such as anti-GAD, can aid in the identification of LADA and encourage a more rapid transition to insulin therapy 1.
• LADA has a strong genetic component, with certain HLA alleles being associated with an increased risk of developing the disease 1.

Diagnosis and Management

• Diagnosis of LADA is based on the presence of autoantibodies, such as anti-GAD, and a clinical presentation consistent with type 1 diabetes 1.
• Management of LADA involves a combination of lifestyle modifications, metformin, and insulin therapy, with the goal of achieving optimal glycemic control and preventing complications 1.

From the Research

Definition and Characteristics of LADA

• Latent Autoimmune Diabetes in Adults (LADA) is a form of autoimmune-mediated diabetes in adults, characterized by a slower progression of beta-cell failure compared to childhood type 1 diabetes 2, 3.
• Patients with LADA present with more preserved beta-cell function than those with classic type 1 diabetes 2.
• The diagnosis of LADA is based on three features: age over 35 years, the presence of at least one of four circulating autoantibodies to pancreatic islet cell antigens, and lack of requirement for insulin at least 6 months after diagnosis 2, 3.

Clinical Presentation and Treatment

• LADA is often misclassified as type 2 diabetes, especially in older adults, due to its mild metabolic decompensation at onset and the possibility of non-insulin treatment for at least 6 months after diagnosis 4, 5.
• Treatment of LADA typically involves early insulin therapy, often combined with metformin in patients with higher insulin resistance 4, 5.
• Other oral antidiabetics, such as incretines, may also be effective in preserving residual beta-cell function 4.

Pathogenesis and Immunotherapy

• LADA is characterized by a slow autoimmune damage of pancreatic β cells, with differences in genetic background, autoimmune response, and clinical metabolic characteristics compared to type 1 and type 2 diabetes 6.
• The disease progression and drug response of patients with LADA are closely related to the level of islet autoimmunity, and exploring the pathogenesis of LADA is crucial for its prevention and treatment 6.
• Therapies targeting the gut microbiota and gut-associated immunity may be potential interventions for LADA, aiming to halt or delay the process of autoimmunity 6.