A Quick Guide to Understanding Latent Autoimmune Diabetes

What Is Diabetes?

Diabetes is a condition where the body cannot produce enough insulin. It is primarily divided into two types, type 1 diabetes (T1DM) and type 2 diabetes (T2DM). One more condition called latent autoimmune diabetes of adults (LADA) also comes under diabetes. Let us look into what we know about LADA.

What Is Latent Autoimmune Diabetes?

LADA is a unique form of diabetes that begins in adulthood. Individuals with LADA don't initially require insulin for managing blood sugar levels. It has similar immunological, genetic, and metabolic characteristics to both T1DM and T2DM.

Unofficially, LADA is also referred to as 1.5 diabetes since it is said to be a form of T1DM due to both being autoimmune diseases, meaning that in both conditions, the body’s immune system attacks and destroys insulin-producing cells. LADA shares some similarities with T2DM and can sometimes be wrongly identified as T2DM because it develops over a longer period of time compared to T1DM.

Symptoms of Latent Autoimmune Diabetes

Symptoms of LADA can be similar to that of T1DM and T2DM. However, the onset of symptoms is slower compared to T1DM and is more noticeable and quicker to develop than T2DM.

The symptoms include:

• Feeling extremely thirsty
• Passing excess urine
• Losing weight drastically
• Increased tiredness

Diagnosis of Latent Autoimmune Diabetes

LADA usually occurs only in adults aged 30-50 years. The “Immunology for Diabetes Society (IDS)” has provided three criteria for the diagnosis of LADA.

These are:

• The age of the individual should be greater than 35 years at onset.
• Positive autoantibodies to islet beta cells.
• No requirement for insulin for at least the initial 6 months after the diagnosis.

LADA should be suspected in individuals who have additional autoimmune disorders like hypothyroidism, are not significantly overweight, and experience worsening blood sugar control. To ascertain the presence of LADA, doctors may contemplate conducting the glutamic acid decarboxylase antibody test (GAD Antibody Test).

Treatment for Latent Autoimmune Diabetes

The management of LADA lacks a consistent approach as of now. As we know, LADA falls somewhere between T1DM and T2DM, displaying characteristics of both. Initially, oral medication like metformin is commonly prescribed.

Researchers are also exploring methods to delay the need for insulin therapy. Till then, as LADA is not recognised as a separate type of diabetes, the treatment for it can remain the same as the other types of diabetes. The aim is to help you manage your blood sugar levels immediately, start the use of insulin on time, and prevent the development of any complications. Talking to your doctor and discussing a proper treatment is essential for managing LADA.  

Complications of Latent Autoimmune Diabetes

Research suggests that individuals with LADA have a higher prevalence and earlier development of a complication called small-fibre neuropathy (SFN, in which small sensory nerves are affected) compared to those with T2DM.

Some insight about this:

• This occurrence is linked to higher levels of HbA1C (average blood glucose levels for about 3 months) and inadequate blood sugar management.
• Additionally, individuals with LADA experience more severe SFN compared to individuals with T2DM of similar age and duration of diabetes.
• Early detection of hyperglycaemia in individuals with LADA provides a critical opportunity for treatment, which has the potential to reverse SFN and reduce related health issues.

Individuals with LADA have a lower risk of microvascular complications in the first nine years. However, they have a higher risk in later years compared to those with T2DM, even after considering a range of factors. These complications include heart disease, stroke, retinopathy, nephropathy, neuropathy, and foot problems.

Additionally, individuals with LADA exhibit similar levels of carotid artery atherosclerosis (collection of plaque in the arteries) as those with T1DM and T2DM.

The Importance of Timely Management

LADA presents a unique challenge within the realm of diabetes and, with its characteristics bridging between T1DM and T2DM, LADA demands careful diagnosis and management. The identification of coexisting autoimmune disorders and the use of specific antibody tests play a crucial role in detecting LADA.

As research continues to shed light on this enigmatic condition, healthcare professionals strive to change treatment strategies, preserve insulin production, and reduce long-term complications. The evolving understanding of LADA holds the promise of improved outcomes for individuals living with this complex form of diabetes.

Conclusion

Latent Autoimmune Diabetes in Adults (LADA) is a unique form of diabetes that combines characteristics of both Type 1 and Type 2 diabetes. While it may initially appear as Type 2 diabetes due to its slow onset, LADA is an autoimmune condition that requires specific diagnostic tests and treatment approaches. It is essential for individuals with LADA to work closely with healthcare professionals to receive accurate diagnoses and tailored care.

By understanding the distinct features of LADA and its treatment options, those living with this condition can better manage their diabetes and improve their quality of life. Additionally, ongoing research and advancements in diabetes care are likely to lead to improved outcomes and support for individuals with LADA in the future.