Islets of Hope for persons with latent autoimmune diabetes in adults (LADA)

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Chart created by Lahle Wolfe, founder, Islets of Hope

References
(this page & LADA article)

(1) Latent Autoimmune Diabetes in Adults; David Leslie, Cristina Valerie DiabetesVoice.org; 2003

(2) Diabetes Mellitus, Type 1: A Review; eMedicine.com; updated 07/02/2006

(3) Autoimmune diabetes not requiring insulin at diagnosis (latent autoimmune diabetes of the adult): definition, characterization, and potential prevention''. Pozzilli P, Di Mario U. Universita Campus Biomedico and the. Universita La Sapienza, Rome, Italy.

(4) Latent Autoimmune Diabetes in Adults; Mona Landin-Olsson; Department of Diabetology and Endocrinology, University Hospital, S-221 85 Lund, Sweden;  Annals of the New York Academy of Sciences 958:112-116 (2002)

(5) The prevalence of selective IgA deficiency in type 1 diabetes mellitus. APMIS. 1992 Aug; 100(8):709-12.; Liblau RS, Caillat-Zucman, S. Fischer AM, Bach JF Boitard C Department of Clinical Immunology, INSERM U 25, Necker Hospital, Paris, France.; PMID: 1520483 [PubMed - indexed for MEDLINE]

(6) Elevation of IgA levels in the non-insulin-dependent (type II) diabetic patient; CW Gill, WS Bush, WM Burleigh and D Cooke-Gomes ; Diabetes Care, Vol 4, Issue 6 636-639, Copyright © 1981 by American Diabetes Association

(7) Prevalence of GAD65 Antibodies in Lean Subjects with Type 2 Diabetes; A G Unnikrishnan, S K Singh and C B Sanjeevi; Ann. N.Y. Acad. Sci. 1037: 118–121 (2004). doi: 10.1196/annals.1337.018
Copyright © 2004 by the
New York Academy of Sciences

(8) Cellular and Molecular Physiology: Molecular Precursors to Diabetes; Joselin Diabetes Center

(9) Autoanitbodies against islet cell antigens; Euroimmun

(10) Antibodies in type 1 diabetes mellitus; SpecialtyLabs.com

(11)  Diabetes Statistics; Diabetes.com

(12) Statistics by country: type 1 diabetes; WrongDiagnosis.com

(13) Statistics by country: type 2 diabetes; WrongDiagnosis.com

(14) C-peptide test; Labtestsoline.org

(15) Understanding Diabetes; uchsc.edu


Islets of Hope has also authored an article about LADA on Wikipedia.com

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Latent Autoimmune Diabetes in Adults (LADA)
Symptoms, Diagnosis, Treatment, and Prognosis

Join LADA Support Group


Mini Site Index
Chart - Comparison of LADA & types 1 & 2 diabetes
LADA compared with (juvenile) type 1 diabetes and type 2
Related information, Type 1 Diabetes

Comparison of clinical features between
(juvenile) type 1 diabetes, type 2 diabetes and LADA

Feature Type 1 Diabetes Type 2 Diabetes LADA
Nature of onset & age of diagnosis

Usually rapid, over days or weeks.

Occurs in children to young adults, usually age 25 or under, with the highest percentage of cases being diagnosed between early teens and age 20.

Usually over a long period of time (many months or years). Predictors of risk include insulin resistance, prediabetes, gestational diabetes, obesity, PCOS, and metabolic syndrome.

Used to occur mainly in older adults but type 2 diabetes can onset in children through seniors.

Usually presents as type 2 with the destruction of the pancreas occurring slowly, usually over years.

Does not affect children. Typically identified in persons over age 35-40 but may occur in persons as young as age 25.

Genes, triggers & contributing factors

With the exception of idiopathic (no known cause) type 1 diabetes involves genetic factors and an environmental trigger, usually an exposure to a virus.  

Many people carry the genes for type 1 but never get the disease.

Hereditary component. Certain health problems tend to run in families with type 2 including PCOS, metabolic syndrome, and Hashimoto's thyroiditis.

Most common trigger for type 2 diabetes is a sedentary lifestyle and obesity, especially when weight centers around the waistline and abdomen.

Genetic predisposition and environmental trigger are suspected as the causes of LADA.

Weight does not seem to be an indicator of LADA (persons are typically normal weight or thin).(1)

Usually an absence of type 2 diabetes in family history.(4)

Genetic & other Markers

ICA (islet cell antibodies)

IAA (insulin autoantibodies)

IA2 (islet antigen 2)

GAD (GAD65-AAGAD)

IgA (deficiency)

HLA

ICA - Found in 80% of new cases;  may test positive years prior to onset(10)

IAA - often detected

GAD - yes, but more commonly present in adults than in children

IA2 - Found in 50-70% of all newly diagnosed with type 1 diabetes(8)

IgA - higher incidence than seen in general population(7)

HLA - yes

C-peptides - low

ICA - no (15)

IAA - no(15))

GAD - rare, if present may be indication of LADA(1)(7)(15) and/or predictor of future insulin dependence

IgA - Higher incidence than seen in nondiabetic population (one study showed 36% of persons with type 2 have elevated IgA levels)(6)

IA2 - no(15)

HLA - no

C-peptides - normal-high

GAD - very often and more common than in the juvenile form.  80% of persons initially diagnosed with type 2 but test positive for GAD progress to insulin dependency within 6 years.(1)

HLA - yes, often

ICA - positive helps differentiation between LADA and type 2.

IAA - yes, often

IA2 - often (those with both GAD and IA2 progress more rapidly to insulin dependence)(1)

IgA - Higher incidence than seen in nondiabetic population

C-peptides - low

Features at diagnosis

Often DKA, recent weight loss, person is usually thin.

Type 1 diabetes is most often is diagnosed when 80-90% of beta islet cells have been destroyed and hyperglycemia and DKA have occurred. (This occurs rapidly.)

May go undiagnosed for long periods of time.  Often diagnosed by blood glucose measurement tests. Patient typically is overweight and may have had preexisting metabolic disorders (i.e., PCOS, prediabetes).

Recent reports indicate a rise in number of cases of thin persons developing type 2 diabetes.

May be undiagnosed for long periods of time, then identified as non-obesity related type 2 diabetes.

Persons with LADA  typically do not require insulin at onset.

Low c-peptide levels

Treatment Type 1 diabetes always requires daily replacement of insulin and regular blood glucose testing and monitoring for possible complications of diabetes.

For many, in early stages of type 2, changes in lifestyle may control the disease.  Oral insulin sensitizing drugs may be given, as well as antidiabetes medications.  

Although many persons with type 2 would benefit from insulin supplementation, only about 40% are in insulin therapy.(11)  Of these, it is not known how many actually have LADA.

Sulfonylureas may help some insulin-sensitive patients at first, but will not stop or slow down LAD progression. May be severe risk of metabolic disturbance in LADA patients on metformin & sulfonylureas.

Prognosis &
Complications (see chart notes)

Type 1 has no cure. Careful attention to maintaining target blood glucose ranges is a key element to reducing risk of diabetes complications. Prediabetes may be reversed but once type 2 onsets it is irrevers- ible.  Changes in lifestyle are required to prevent complications from diabetes.  More persons with type 2 have amputations than do those with type 1.  No cure. Most persons with LADA will eventually require insulin.  Keeping blood glucose in target ranges will reduce the risk of complications associated with diabetes. No cure.
Prevalence

USA - 367,069(12)

Canada - 40,634(12)

UK - 75,338(12)

USA - 17,273,847(13)

Canada - 1,912,227(13)

UK - 3,545,335(13)

20% of persons diag- nosed as type 2 may have LADA. This accounts for 5-10% of the total diabetes population in the US, the same number as type 1 diabetes.(4)

Chart note:

Diabetes complications of LADA,  type 1, and type 2 diabetes all include an increased risk for diabetic neuropathy, diabetic retinopathy, blindness, chronic wound infections, amputation, kidney failure, cardiovascular problems, sexual and urologic problems, frozen shoulder, and problems during pregnancy.  Type 1 and LADA have a higher risk of diabetic ketoacidosis from hyperglycemia than does type 2 diabetes, but all three types carry a risk of lactic acidosis from high blood glucose.  For those on the drug metformin the risk of lactic acidosis is even higher.

See "Diabetes Complications" for more information.


Summary of LADA compared with (juvenile) type 1 and type 2 diabetes

Onset - Juvenile diabetes onsets rapidly, and at a younger age than does LADA.  Both LADA and type 2 onset is slow, over many months or years.

Family history - There is often an absence of family history of type 2 diabetes in a LADA patient's family. 

Antibodies - Persons with type 1 diabetes and LADA usually test positive for certain (same) antibodies that are not present in type 2 diabetes (see table above).  

GAD antibodies - Persons with LADA usually test positive for GAD antibodies, whereas in type 1 diabetes these antibodies are more commonly seen in adults rather than in children.[2] 

Insulin sensitivity - Persons with LADA are not insulin resistant (and in fact may be insulin sensitive) as in the case of type 2 diabetes and prediabetes. 

Lifestyle and excess weight - Type 2 diabetes may onset as a result of a sedentary lifestyle and excess body weight (especially when excess weight is carried about the center, or in those with an "apple" shaped body).  These factors are not currently thought of as contributing factors to the onset of type 1 diabetes or LADA.  Persons with LADA are often normal body weight or thin. 

Treatment - Although LADA may appear to initially respond to similar treatment (lifestyle and medications) for type 2 diabetes, it will not halt or slow the progression of beta cell destruction and persons with LADA will eventually become insulin dependent. 

Prognosis - About 80% of all persons initially diagnosed with type 2, who also have GAD antibodies, will become insulin dependent within 6 years.  Those with both GAD and IA2 antibodies will become insulin dependent sooner.  LADA occurs slowly, but progresses towards insulin dependency.[1]

         

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Page Updated 07/24/2006