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LADA (Latent Autoimmune Diabetes in Adults)

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LADA (Latent Autoimmune Diabetes in Adults) is an autoimmune condition just like type 1 diabetes, however the rate at which the cells of the pancreas are destroyed is slower. Characteristics of LADA seem to overlap with type 1 and type 2 diabetes, that’s why some people call it type 1 ½ diabetes.

About LADA?

In autoimmune diabetes a person’s immune system attacks the insulin producing beta cells of their pancreas by mistake. This means the pancreas can no longer produce insulin. People with type 1 diabetes need insulin therapy from the time they are diagnosed. In comparison, people with LADA are usually still producing some insulin at diagnosis. How much insulin they make, and at which point they will need insulin therapy is very individual, so in this way they are similar to people with type 2 diabetes.

Type 2 diabetes happens when insulin doesn’t work properly because of insulin resistance and the pancreas can’t make enough insulin to overcome this. Type 2 diabetes becomes more common as people get older. If people with LADA are older when diagnosed, it is often assumed they have type 2 diabetes, especially if overweight. Also, lifestyle changes and glucose lowering medication can help at first, just like in someone with type 2 diabetes. These are some reasons why people with LADA are often misdiagnosed as having type 2 diabetes.

How is LADA classified?

The World Health Organisation (WHO) classifies types of diabetes into categories or groups. These are updated as more information is learned. In 2019, the WHO renamed and reclassified LADA. They classified it as ‘Slowly Evolving Immune-Mediated Diabetes’ (SEIMD). In practice, this classification does not change what we know about LADA, the way it is diagnosed or managed, and any of the outcomes. In fact, amongst the diabetes experts and the diabetes community, it continues to be referred to as LADA.
 

What are the features of LADA?

It can be hard for health professionals to distinguish between LADA and other types of diabetes. Some people may have very high glucose levels when first diagnosed, while others may have moderately high glucose levels. People with type 2 diabetes are most commonly diagnosed over 40 years of age. People with type 1 diabetes are usually diagnosed under 30 years of age. LADA usually occurs after the age of 30 years. Some people with LADA may be overweight, as is often seen in people with type 2 diabetes. Others may be lean as is often seen at diagnosis in type 1 diabetes. As you can see, LADA is a bit like type 1 diabetes and a bit like type 2 diabetes. This is why LADA was sometimes referred to as type 1.5 diabetes.

Whether diagnosed correctly or not, initially many people with LADA can be managed with eating and exercise alone. However, they often need glucose lowering medication sooner than those with type 2 diabetes. If diagnosed with type 2 diabetes, this might prompt their health professional to consider LADA.

How do we know if someone has LADA?

A health professional will take a detailed medical and family history, and confirm LADA by doing a blood test that checks for diabetes-related autoantibodies. These autoantibodies are proteins in the blood showing that a person’s own immune system is attacking the beta cells of their pancreas. This does not happen in people with type 2 diabetes.

Antibodies are:

  • proteins produced by the immune system to fight illness or infection.
  • antibodies that mistakenly fight organs, tissues or cells of the body.

Autoantibodies are not the cause of disease but a sign that this damage is happening.

A C-peptide blood test may also be done. C-peptide shows how much insulin the body is making. This can help decide on when to start insulin therapy. C-peptide levels decrease more slowly in LADA than in type 1 diabetes.
Like people with type 1 diabetes, people with LADA are more likely to have another autoimmune condition; for example thyroid disease or rheumatoid arthritis.

How is LADA treated? 

Most people with LADA will eventually need insulin therapy to manage their diabetes. At diagnosis, lifestyle changes are very important, especially if someone is overweight. Other glucose lowering medication may be used as well.

Since people with LADA are very different to each other, their management needs to be tailored for them.

What education does a person with LADA need?

People with LADA need education in many areas of diabetes care; including blood glucose monitoring, healthy eating, physical activity and medication management. Eventually, most people with LADA are treated in the same way that people with type 1 diabetes are. A person with LADA who needs insulin therapy at least 4 times per day may be referred to a structured type 1 diabetes education program such as OzDAFNE or insulin pump therapy.

What about complication screening?

Regular diabetes health checks need to occur from diagnosis to screen for complications of diabetes.

Just like in type 1 diabetes, people with LADA should be regularly screened for other autoimmune conditions such as thyroid and coeliac diseases.

There is still a lot to be learned about LADA. More research in this area will increase our understanding of identifying people with LADA and improve best management practices.

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