Diabetes
LADA
Diabetes
occurs in many types beyond type 1 diabetes and type
2 diabetes. One of these is Latent Autoimmune Diabetes
of Adulthood (LADA). Some patients receive the diagnosis
of type 2 diabetic, despite not exhibiting all the
classic symptoms associated with this condition. In
some instances, a more accurate diagnosis would be
LADA.
Characteristics
of LADA
- Adult
age at diagnosis (usually over 25 years of age)
- Initial
presentation masquerades as non-obese type 2 diabetes
(does not present as diabetic ketoacidosis)
- Initially
can be controlled with meal planning with or without
diabetes pills
- Insulin
dependency gradually occurs, frequently within months
- Positive
antibodies
- Low
C-peptide levels.
- Unlikely
to have a family history of type 2 diabetes.
How does
LADA differ from type 2 diabetes?
Patients
with LADA may lack some of the type 2 diabetes symptoms.
These could include age, obesity, and the difficulty
in achieving glycaemic control using standard oral
hypoglycaemic agents. If these are lacking from diagnosis,
it is quite possible that the patient has LADA. LADA
is more typical of the immune markers common to type
2 diabetes, yet in its early stages does not require
insulin. Patients in the early stages of LADA may
also lack ketoacidosis symptoms. However, there may
be a more rapid progression to requiring insulin amongst
LADA patients when compared to normal type 2 diabetics.
LADA patients share features common to both type 1
and type 2 diabetics.
How common
is LADA?
According
to the UK Prospective Diabetes Study found that antibodies
specific to LADA cases are found in between 6 and
10 per cent of diabetes cases. Amongst younger patients,
the incidence is more common.
How is
LADA diagnosed?
Determining
the presence of LADA is achieved by examining the
presence of elevated levels of pancreatic autoantibodies
amongst patients who have recently been diagnosed
with diabetes but do not require insulin. These antibodies
can identify LADA, and also can predict the rate of
progression towards insulin dependency.
Are some
people more prone to LADA?
There are
some clues that can give rise to a clinical suspicion
of LADA. These include:
- An absence
of metabolic syndrome features
- Uncontrolled
hyperglycaemia despite using oral agents
- Evidence
of autoimmune diseases (including Graves' disease
and Anaemia)
Those patients
who have LADA and also exhibit features of metabolic
syndrome are sometimes termed type 1.5 diabetics.
What complications
are related to LADA?
Ketoacidosis
is a long-term complication of LADA, particularly
once insulin dependence develops. Cardiovascular disease
risks are similar to those of type 2 diabetics, but
if this complication develops hyperglycaemia is a
stronger risk factor. Microvascular complications
such as retinopathy and neuropathy are similar to
those people with type 2 diabetes.
How is
LADA managed?
The treatment
of LADA needs to focus on controlling hyperglycaemia
and preventing the onset of any complications. It
is important to preserve beta cell function amongst
LADA patients for as long as possible. Insulin can
be used to treat LADA, as can metformin and thiazolidinediones.
Anything that can help to restore beta cell function
should be considered.
