September 23, 2022

When most hear the word “diabetes”, they think Type 1 or Type 2. The fact is there are several subtypes of diabetes. Today we will highlight Latent Autoimmune Diabetes in Adults, abbreviated LADA.

To better understand what happens in diabetes, consider what is normal:

  • Food is consumed, digested, and broken down into proteins, fats, carbohydrates, vitamins, and minerals.
  • Carbohydrates are broken down into glucose, or blood sugar, and absorbed into the blood stream.
  • As blood glucose rises, the pancreas produces insulin. Insulin acts like a key and opens cell doors so glucose can enter and feed the cells.

When diabetes is present, things are not working as they should.

Type 1 diabetes is an autoimmune disorder. It is caused by the body’s own immune system malfunctioning and destroying the cells in the pancreas that make insulin. Blood glucose rises because there aren’t enough keys to unlock cell doors. Injecting insulin provides the keys to control blood glucose. This typically occurs over a period of weeks. Although type 2 diabetes can occur at any age, most people associate its onset with a younger population.

Type 2 diabetes is the result of the body not being able to use the insulin it makes. This is called “insulin resistance” since the body resists the efforts of insulin. In other words, the keys don’t fit the locks on the cell doors. Some diabetes medications work to fix the cell locks. Other medications work in other ways.  Ultimately, type 2 diabetes develops slowly and typically develops over years. Additionally, type 2 diabetes is associated with an older adult population.

LADA is a less common and often misdiagnosed form of diabetes. It is actually a form of Type 1 diabetes caused by the body’s immune system. As a reminder, a LADA diagnosis means the cells that tell the body to produce insulin are attacked and destroyed, but at a much slower rate than that of Type 1 diabetes. LADA is frequently misdiagnosed as Type 2 diabetes because of its slow development and often being diagnosed well into adulthood. LADA is typically diagnosed being people aged 30-50 years old.

 

Diagnosis

Getting the proper diagnosis can be tricky with LADA. However, there are key markers that may trigger a reconsideration of a type 2 diagnosis and closer look into the culprit of elevated blood glucose. A diabetes diagnosis often follows the results of fasting blood glucose, hemoglobin A1c, and/or even an oral glucose tolerance tests. A diagnosis of LADA recommends the following examinations:

  • Autoantibodies: Glutamic acid decarboxylase (GAD) and Islet cell antibodies (ICAs) being the most common autoantibody indicators of LADA
  • Lack of other metabolic disorder markers such as high cholesterol, elevated blood pressure, overweight/obesity
  • Elevated glucose despite use of typical oral agents used to treat Type 2 diabetes
  • Other autoimmune disorders that may be present such as Grave’s Disease, Hashimoto’s, Celiac disease
  • Oral diabetes medications are not lowering blood glucose as expected
  • C-peptide levels: an indicator of pancreatic insulin output

 

Treatment

There’s no one size fits all treatment for Latent Autoimmune Diabetes in Adults. A multitude of factors will determine how quickly a person’s own insulin diminishes, response to oral and/or injectable diabetes medications, and the best lifestyle treatment necessary to thrive with LADA.

  • Medication: ultimately, it’s well-established that at some point in a person’s LADA journey, insulin will be a necessary part of day-to-day living. It’s undetermined how long a person with LADA can carry on successfully managing blood sugars without insulin treatment.
    • Beneficial Oral Medications for LADA
      • Metformin may be helpful if insulin resistance is also a factor in elevated blood glucose but may not benefit
      • TZD or thiazolidinedione drugs help safeguard beta cell function in people with LADA
      • Dipeptidyl peptidase 4 inhibitors (DPP‐4i) in patients with LADA suggest that this class of hypoglycemic agents might improve glycemic control and preserve beta cell function
    • Potentially Harmful Oral Medications for LADA
      • Sulfonylureas may actually worsen LADA by increasing autoimmunity
    • Injectable Medications for LADA
      • Injectable incretin mimetic drugs have not been specifically tested in persons with LADA but have been shown to increase beta-cell growth and improve glucose control in studies
      • Insulin has been shown to protect beta cells from damage if introduced earlier in a LADA diagnosis and will lower blood glucose levels

With an estimated 12% of all persons diagnosed with diabetes having Latent Autoimmune Diabetes in Adults, it’s certainly something to consider if treatment response doesn’t meet expectations of the initial diagnosis. Ultimately, one should work closely with their trusted healthcare team in order to customize diagnosis and treatment for their body.