Latent Autoimmune Diabetes in Adults: Definition, Prevalence, {beta}-Cell Function, and Treatment.

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Abstract

Latent autoimmune diabetes in adults (LADA) is a disorder in which, despite the presence of islet antibodies at diagnosis of diabetes, the progression of autoimmune ß-cell failure is slow. LADA patients are therefore not insulin requiring, at least during the first 6 months after diagnosis of diabetes. Among patients with phenotypic type 2 diabetes, LADA occurs in 10% of individuals older than 35 years and in 25% below that age. Prospective studies of ß-cell function show that LADA patients with multiple islet antibodies develop ß-cell failure within 5 years, whereas those with only GAD antibodies (GADAs) or only islet cell antibodies (ICAs) mostly develop ß-cell failure after 5 years. Even though it may take up to 12 years until ß-cell failure occurs in some patients, impairments in the ß-cell response to intravenous glucose and glucagon can be detected at diagnosis of diabetes. Consequently, LADA is not a latent disease; therefore, autoimmune diabetes in adults with slowly progressive ß-cell failure might be a more adequate concept. In agreement with proved impaired ß-cell function at diagnosis of diabetes, insulin is the treatment of choice.

In 1986, Groop et al. (1) reported a subgroup of type 2 diabetic patients who, despite having islet autoantibodies, showed preserved ß-cell function. The type of diabetes in these patients was referred to as latent type 1 diabetes, showing clearly different features from classic type 1 and classic type 2 diabetes. Later, Tuomi et al. (2) and Zimmet et al. (3) launched the eponym LADA (latent autoimmune diabetes in adults) for this slowly progressive form of autoimmune diabetes initially managed with diet and oral hypoglycemic agents before becoming insulin requiring. However, it is now clear that classic autoimmune type 1 diabetes (4) is frequent among patients older than 30 years at diagnosis of diabetes. Whether LADA is a separate entity from conventional autoimmune type 1 diabetes among adults may therefore be challenged. In this article, we review LADA with regard to definitions and our experience with ß-cell function and discuss treatment. The question as to whether the eponym LADA still should be used will also be considered.

Detaljer

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Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Endokrinologi och diabetes
Originalspråkengelska
Sidor (från-till)S68-S72
TidskriftDiabetes
Volym54
Utgåva nummerSuppl 2
StatusPublished - 2005
PublikationskategoriForskning
Peer review utfördJa