LADA: Latent Autoimmune Diabetes in Adults

Introduction

Latent Autoimmune Diabetes in Adults (LADA) is a form of autoimmune diabetes that shares characteristics with both Type 1 and Type 2 diabetes. LADA is often misdiagnosed as Type 2 diabetes since it typically occurs in adults over the age of 30, but it has the same pathophysiology as Type 1 diabetes which leads to insulin dependence over time.

During residency I created a presentation about LADA which can be seen here.

Definition

LADA is defined as an autoimmune condition where the immune system mistakenly attacks insulin-producing beta cells in the pancreas. Unlike Type 1 diabetes, which usually manifests in childhood or adolescence, LADA appears later in life and has a more gradual onset.

Prevalence in the United States

Recent estimates suggest that LADA accounts for approximately 5-10% of all diabetes cases in adults. While precise figures are still being studied, LADA is increasingly recognized as a distinct form of diabetes, highlighting the importance of awareness among healthcare providers and patients due to the different treatment recommendations.

 

Pathophysiology: What Sets LADA Apart?

- LADA vs. Type 1 Diabetes:

In Type 1 diabetes, the autoimmune attack on beta cells is rapid and typically occurs in childhood. In contrast, LADA involves a slower, more gradual destruction of these cells, leading to a delayed need for insulin therapy.

- LADA vs. Type 2 Diabetes:

Type 2 diabetes is often associated with insulin resistance and is generally influenced by lifestyle factors. In LADA, the autoimmune destruction of beta cells results in a deficiency of insulin production, similar to Type 1.

Treatment Approaches

- Initial Management:

Many patients with LADA are initially treated with oral hypoglycemic agents or GLP1 agonists, similar to those with Type 2 diabetes. However, as the disease progresses, insulin therapy becomes necessary.

- Ongoing Management:

As beta-cell function declines, insulin therapy is essential to manage blood glucose levels effectively. This is a key differentiator from Type 2 diabetes, where patients may remain on oral medications or GLP1 agonists for a longer period of time (or indefinitely).

Conclusion

LADA is a unique form of diabetes that requires careful diagnosis and management. Understanding its distinct characteristics compared to Type 1 and Type 2 diabetes is crucial for effective treatment and care. Increased awareness and research into LADA will help improve outcomes for those affected by this condition.