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.
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.
