Wow. How nice to see a medic saying what many of us know from our own experience and that the NHS could do well to note. Even NICE is now beginning to accept LADA.It is somewhat of a complex process depending on peoples' antibodies or some such, but here is an article
http://care.diabetesjournals.org/content/29/5/970.long
http://care.diabetesjournals.org/content/29/5/970.full.pdf+html
The bottom line is that there are certain drugs, like Byeta, sitagliptin and others which are not supposed to be given to LADA folks. Also, the amount of time the process takes for onset is also of concern
general
http://diabetes.diabetesjournals.org/content/54/suppl_2/S68.full.pdf+html
A testing opinion is here by
Bruce Bode, MD
Atlanta Diabetes Associates
JDRF Research Team/ CGMS
"LADA is just a subset of Type 1 diabetes occurring later in life. IT IS TYPE 1 DM!! NOTHING MORE OR LESS. We see Type 1 presenting all the time in adulthood but most primary care physicians and even endos and CDEs miss it, thinking it is burned out Type 2 diabetes.
"All patients presenting the hyperglycemia that is not classic Type 2 diabetes (obese, direct relative with Type 2 DM, no weight loss) should be screened for auto-antibodies to the Islet cell or insulin (ICA, GAD, IA2, IAA, and Zn T - autoimmunity marker tests). If positive, treat as a Type 1 with multiple daily injections or insulin pump therapy. If negative, still treat with insulin if symptomatic then revert to metformin plus incretins, with or without a TZD drug.
This should be standard of care but it is not."
Good questions. My two diabetes GPs weren't aware of LADA and I had an argument with my current one who said you aren't a T1 therefore you are T2 (I was diagnosed with a urine stick in the doctors office!). I was stick thin all the time. I gave up with them and paid for my own two tests (c-peptide and GAD) done privately. The GAD was negative and the c-peptide showed quite low insulin. I've since learned from the 2015 NICE Diabetes T1 Guidelines that the GAD test becomes less reliable as time passes after diagnosis but the c-peptide becomes more reliable. The Guidelines also say the GP should take note of anyone who is slim. My test was 7 years after diagnosis. There are a good few known antibodies beyond GAD and IA-2 but they are rarer. Some labs that do GAD also do IA-2 as well. There are other causes of islet cell failure including viruses and pancreatitis. In my case for various reasons I believe I had some form of inflammation of the pancreas. GPs are reluctant to do the two tests anyway partly due to ignorance of their existence or the cost to the NHS. The acronym LADA implies antibody destruction but it isn't just antibodies which is why my siggie says T1.5 and not LADA. The bottom line is that a low c-peptide means you need insulin - whatever the cause. If the GP refuses to accept the point then you need to ask for a referral to the clinic or pay for the two tests yourself (approx £300). I'm still listed as T2 but I know I'm T1 hence the NHS diabetes stats are messed-up and this affects the focus of research.
