Diabetes occurs in many types beyond type 1 diabetes and type 2 diabetes. One of these is Latent Autoimmune Diabetes of Adulthood (LADA). Some patients receive the diagnosis of type 2 diabetic, despite not exhibiting all the classic symptoms associated wi (2023)

LADA stands for Latent Autoimmune Diabetes of Adulthood. LADA is a form of type 1 diabetes that develops later into adulthood.

LADA tends to develop more slowly than type 1 diabetes in childhood and, because LADA can sometimes appear similar to type 2 diabetes, doctors may mistakenly diagnose LADA as type 2 diabetes.

The definition provided by Prof. David Leslie, Principle Investigator of Action LADA, is that in Europe:

LADA is defined as initially non-insulin requiring diabetes diagnosed in people aged 30-50 years with antibodies to GAD – glutamic acid decarboxylase.

How does LADA compare with other diabetes types?

LADA is sometimes referred to as type 1.5 diabetes. This is not an official term but it does illustrate the fact that LADA is a form of type 1 diabetes that shares some characteristics with type 2 diabetes.

As a form of type 1 diabetes, LADA is an autoimmune disease in which the body’s immune system attacks and kills off insulin producing cells.

The reasons why LADA can often be mistaken for type 2 diabetes is it develops over a longer period of time than type 1 diabetes in children or younger adults.

Whereas type 1 diabetes in children tends to develop quickly, sometimes within the space of days, LADA develops more slowly, sometimes over a period of years.

The slower onset of diabetes symptoms being presented in people over 35 years may lead a GP to initially diagnose a case of LADA as type 2 diabetes.

Symptoms of LADA

The first symptoms of LADA include:

  • Feeling tired all the time or regularly tired after meals
  • Foggy headedness
  • Experiencing hunger soon after meals

As LADA develops, a person’s ability to produce insulin will gradually decrease and this may lead to symptoms such as:

  • A hard to quench thirst
  • Needing to frequently urinate
  • Blurred vision
  • Tingling nerves

It is important to catch the symptoms at the earliest stage because diagnosis of LADA at a later stage increases the risk of developing diabetes complications.

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Having tingling nerves can be a sign of neuropathy (nerve disease) so if this symptom is appearing regularly, especially if in addition to other symptoms listed above, it is advisable to see a doctor.

How common is LADA?

According to the UK Prospective Diabetes Study found that antibodies specific to LADA cases are found in between 6% and 10% of diabetes cases. Amongst people diagnosed with diabetes at an age younger than 35 years old, LADA may account for up to 25% of cases.

How is LADA diagnosed?

Often LADA will be initially diagnosed as diabetes by way of the usual diagnosis procedures.

Following a diagnosis of diabetes, your doctor or you may have reason to suspect that the type of diabetes present is LADA.

Determining the presence of LADA is achieved by examining the presence of elevated levels of pancreatic autoantibodies amongst patients who have recently been diagnosed with diabetes but do not require insulin.

A GAD Antibody test can measure the presence of these autoantibodies.

These antibodies can identify LADA, and also can predict the rate of progression towards insulin dependency.

Another test that can be performed is a C-peptide test. However, C-peptide tests may not always draw conclusive results in people with LADA at an earlier stage of the condition’s development.

Transcript

LADA is a specific type of diabetes that affects adults. It shares some similarities of both type 1 and type 2 diabetes and may often be diagnosed as one of these instead of as LADA.

LADA stands for Latent Autoimmune Diabetes of Adults. Latent means it comes on slowly – in this way it’s similar to type 2 diabetes. Autoimmune is where the body attacks its own insulin producing cells; similar to type 1 diabetes

LADA has the classic symptoms of diabetes. These are increased thirst, increased need to urinate, fatigue, dry mouth, blurry vision, slow healing of cuts or sores.

Pointers that might indicate LADA include the symptoms having come on over a period of several weeks or longer, you have someone with type 1 diabetes in your close family, you have another autoimmune condition such as Rheumatoid Arthritis or Coeliac disease.

If one or more of these apply then you may be given a GAD test to help determine what diabetes type you may have. GAD means a glutamic acid decarboxylase test.

LADA is a type of diabetes that is not completely understood and not all doctors may be fully aware of LADA as separate form of diabetes.

It is not uncommon for LADA to be misdiagnosed as type 2 diabetes in some cases.

There is some debate as to how LADA should be treated. Some people may be put onto tablets such as metformin whereas others may go onto insulin.

Insulin may increase the likelihood of hypoglycemia, low blood sugar, happening but could help to slow down the loss of insulin producing cells. As with other types of diabetes, eating a healthy, balanced diet and getting activity into each day comes recommended.

Reducing your carbohydrate intake in favour of less starchy vegetables should help to regulate blood sugar levels.

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Transcript

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LADA can be misdiagnosed

As noted, because of the age at which it can develop and the slower onset of the condition, LADA can often be mistakenly misdiagnosed as type 2 diabetes.

It is beneficial if LADA is diagnosed correctly as if LADA is incorrectly diagnosed as type 2 diabetes, it could lead inappropriate treatment methods that could lead to poorer diabetes control and could accelerate the loss of insulin producing ability.

There are some clues that can give rise to a clinical suspicion of LADA rather than type 2 diabetes. These include:

  • An absence of metabolic syndrome features such as obesity, high blood pressure and cholesterol levels
  • Uncontrolled hyperglycemia despite using oral agents
  • Evidence of other autoimmune diseases (including Graves’ disease and Anaemia)

Note that some people with LADA can exhibit features of metabolic syndrome such as being overweight or obese which may complicate or delay a diagnosis of LADA.

How is LADA treated ?

Because LADA develops slowly, someone with LADA may be able to produce enough of their own insulin to keep sugar levels under control without needing insulin for a number of months or sometimes even years after the initial diagnosis of diabetes.

Insulin will almost certainly be required at some point in the future.

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In some cases, insulin therapy may be postponed. However, there is evidence to suggest that starting insulin treatment soon after a diagnosis of LADA will help to better preserve the pancreas’ ability to produce insulin.

Regular blood glucose testing is advised for people with LADA at a similar number of tests per day that are advised for people with type 1 diabetes.

This means that it is advisable to test your blood sugar levels before each meal and before bed. [181]

What complications are related to LADA?

Ketoacidosis is a short-term complication of LADA, particularly once the pancreas has lost much of its ability to produce insulin

People with LADA should be aware of the signs of ketoacidosis and how to test for ketones if needed.

The risks of long term complications of diabetes will be similar to the risks in people with type 1 and type 2 diabetes.

The possible long term complications of diabetes include:

  • Heart disease and stroke
  • Retinopathy (retinal disease)
  • Nephropathy (kidney disease)
  • Neuropathy (nerve disease)
  • Foot problems

What complications are related to LADA?

Ketoacidosis is a long-term complication of LADA, particularly once insulin dependence develops.

Cardiovascular disease risks are similar to those of type 2 diabetics, but if this complication develops hyperglycaemia is a stronger risk factor.

Microvascular complications such as retinopathy and neuropathy are similar to those people with type 2 diabetes.

How is LADA managed?

The treatment of LADA needs to focus on controlling hyperglycaemia and preventing the onset of any complications.

It is important to preserve beta cell function amongst LADA patients for as long as possible. Insulin can be used to treat LADA, as can metformin and thiazolidinediones

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Anything that can help to restore beta cell function should be considered.

FAQs

What is the difference between type 1 diabetes and LADA? ›

Whereas type 1 diabetes often develops rapidly, LADA is not as rapid and presents like a slowly progressing form of type 1 diabetes. Because β-cell function is lost more gradually than in type 1 diabetes but more rapidly than in type 2 diabetes, patients may initially respond to noninsulin glucose-lowering agents.

What is LADA or type 1.5 diabetes and why is it called double diabetes? ›

Type 1.5 diabetes is a form of “double” diabetes because people with this condition show both the autoimmune destruction of beta cells of type 1 diabetes and the insulin resistance characteristic of type 2 diabetes.

What triggers LADA diabetes? ›

The cause of LADA is the development of autoantibodies against pancreatic cells, insulin, or enzymes involved in pancreatic functions. Antibodies affecting the pancreas and its function may influence the way the body responds to blood sugar.

What type of diabetes is LADA? ›

Latent autoimmune diabetes in adults (LADA) is a slow-progressing form of autoimmune diabetes. Like the autoimmune disease type 1 diabetes, LADA occurs because your pancreas stops producing adequate insulin, most likely from some "insult" that slowly damages the insulin-producing cells in the pancreas.

Is type 2 diabetes autoimmune? ›

This type of disorder occurs when your body's natural chemical processes don't work properly. However, some research now suggests that type 2 diabetes may be an autoimmune disease. If so, it may be possible to treat it with new approaches and preventive measures.

Is latent autoimmune diabetes hereditary? ›

In general, LADA is genetically related to both T1DM and T2DM, but the strongest genetic risk locus is shared with T1DM.

What is the difference between type 1 and type 1.5 diabetes? ›

It's a slow-progressing form of autoimmune diabetes, like type 2 diabetes. Like the autoimmune disease type 1 diabetes, it occurs as the pancreas stops insulin production. But unlike type 1 diabetes, people with type 1.5 often do not need insulin for several months up to years after they are diagnosed.

What is the difference between LADA and MODY? ›

If you're like a lot of people, you probably think there are two kinds of diabetes: type 1 and type 2. But there are some forms of the disease that don't fit neatly into those groups. MODY (maturity-onset diabetes of the young) and LADA (latent autoimmune diabetes in adults) are two prime examples.

How is LADA diabetes diagnosed? ›

To diagnose LADA, the Immunology of Diabetes Society has established three main criteria including: (1) adult age of onset (>30 years); (2) presence of any islet cell autoantibody; and (3) absence of insulin requirement for at least 6 months after diagnosis [9].

What exactly does metformin do to your body? ›

Metformin works by helping to restore the body's response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.

Can LADA be reversed? ›

Unlike people with type 2 diabetes who may never need insulin and who can reverse their diabetes with lifestyle changes and weight loss, people with LADA can't reverse their condition. If you have LADA, you'll eventually be required to take insulin to stay healthy.

Can you have LADA and be overweight? ›

Overweight/obesity is associated with increased risk of LADA, particularly when in combination with FHD. These findings support the hypothesis that, even in the presence of autoimmunity, factors linked to insulin resistance, such as excessive weight, could promote onset of diabetes.

Does Metformin help LADA? ›

Since LADA patients have some degree of insulin resistance, metformin is beneficial.

Can autoimmune diabetes be cured? ›

Among them, type 1 diabetes, also named autoimmune diabetes, afflicts 10 million people worldwide. This disease is caused by autoimmunity-mediated destruction of pancreatic β-cells, leading to insulin deficiency, hyperglycemia and complications. Currently, there is no cure for type 1 diabetes.

How common is latent autoimmune diabetes? ›

Such patients identified as having latent autoimmune diabetes of adults (LADA) account for 2–12% of all patients with diabetes, with considerable variability according to ethnicity, type of autoantibody used for screening (most often autoantibody against glutamic acid decarboxylase [GADA]), and method of ascertainment ...

Is type 1 diabetes always autoimmune? ›

Type 1 diabetes (T1D) is an organ-specific autoimmune disease caused by the autoimmune response against pancreatic β cells.

How do you test for autoimmune disease? ›

There's usually no single test to diagnose autoimmune disease. You have to have certain symptoms combined with specific blood markers and in some cases, even a tissue biopsy. It's not just one factor.” Diagnosis can also be difficult because these symptoms can come from other common conditions.

Can Sjogren's syndrome cause diabetes? ›

Type 1 diabetes is also an autoimmune disease, except it attacks insulin-producing cells in the pancreas. Now researchers at the Garvan Institute in Sydney have identified a unique immune cell that is associated with Sjögren's syndrome, and which also appears to be involved with type 1 diabetes.

Does LADA run in families? ›

Some reports suggest that LADA patients are unlikely to have family history of type 2 diabetes [10] while a recent study (Nord-Trøndelag Health Study) indicated strong evidence of family history as an important risk factor for LADA [11].

How long can you have type 1 diabetes without knowing it? ›

It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe. Some type 1 diabetes symptoms are similar to symptoms of other health conditions.

Is LADA better than type 1? ›

As a form of type 1 diabetes, LADA is the result of your immune system attacking the beta cells in your pancreas that produce insulin. The only difference is that this attack is slower which means your insulin production declines at a more slower rate compared to type 1—but a much faster rate compared to type 2.

Is type 1 autoimmune disease? ›

Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from making insulin. It requires daily management with insulin injections and blood sugar monitoring. Both children and adults can be diagnosed with Type 1 diabetes.

Can type 2 diabetics become type 1? ›

Type 2 diabetes cannot turn into type 1 diabetes. However, a person who originally receives a diagnosis of type 2 diabetes may still get a separate diagnosis of type 1 at a later date. Type 2 diabetes is the most common type, so a doctor might initially suspect that an adult with diabetes has type 2.

What can cause type 1 diabetes in adults? ›

What causes type 1 diabetes? Type 1 diabetes occurs when your immune system, the body's system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease.

Is MODY diabetes reversible? ›

MODY is caused by a genetic mutation passed on through the family. There's currently no way to prevent or cure it, but it can be managed, and predicted.

Is MODY diabetes rare? ›

MODY is a rare form of diabetes which is different from both type 1 and type 2 diabetes, and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have, has a 50% chance of inheriting it from them.

How do you manage LADA diabetes? ›

Treating LADA

You'll usually start taking oral medication, usually metformin, and go on to insulin as your blood sugar levels start to go up. You tend to go on to insulin much quicker than you would normally if you had type 2 diabetes.

What can mimic diabetes symptoms? ›

  • Alcoholism.
  • Alzheimer's Disease.
  • Amenorrhea.
  • Amyloidosis.
  • Anorexia Nervosa.
  • Bulimia Nervosa.
  • Chronic Obstructive Pulmonary Disease.
  • Cirrhosis.

Can you become allergic to insulin? ›

Allergy to human insulin or its analogs is rare, with an estimated incidence of <1% to 2.4% in insulin-treated diabetic patients. However, cases of insulin allergy continue to be reported and range from local injection site reactions to generalized life-threatening anaphylaxis.

Can type 1 diabetes be reversed? ›

The truth is, while type 1 diabetes can be managed with insulin, diet and exercise, there is currently no cure. However, researchers with the Diabetes Research Institute are now working on treatments to reverse the disease, so that people with type 1 diabetes can live healthy lives without medication.

What is the difference between type 1 and type 1.5 diabetes? ›

It's a slow-progressing form of autoimmune diabetes, like type 2 diabetes. Like the autoimmune disease type 1 diabetes, it occurs as the pancreas stops insulin production. But unlike type 1 diabetes, people with type 1.5 often do not need insulin for several months up to years after they are diagnosed.

How do you know if you have LADA? ›

The only way to confirm a diagnosis of LADA is through a blood test that checks for antibodies against the insulin-making cells of the pancreas. Your doctor may also check for levels of a protein called C-peptide to get information on how much insulin your body is making.

How long does LADA take to develop? ›

Simply put, LADA is a form of type 1 diabetes that progresses remarkably slowly, over the course of decades instead of years, which means people with LADA are usually between the ages of 20 to 40 years old, and need very small amounts of insulin -- if any -- for the first many years after diagnosis.

Can you reverse LADA diabetes? ›

Unlike people with type 2 diabetes who may never need insulin and who can reverse their diabetes with lifestyle changes and weight loss, people with LADA can't reverse their condition. If you have LADA, you'll eventually be required to take insulin to stay healthy.

Is type 1 autoimmune disease? ›

Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from making insulin. It requires daily management with insulin injections and blood sugar monitoring. Both children and adults can be diagnosed with Type 1 diabetes.

Is type 1 diabetes an autoimmune disease? ›

Type 1 diabetes (T1D) is an organ-specific autoimmune disease caused by the autoimmune response against pancreatic β cells. T1D is often complicated with other autoimmune diseases, and anti-islet autoantibodies precede the clinical onset of disease.

Can type 2 diabetics become type 1? ›

Type 2 diabetes cannot turn into type 1 diabetes. However, a person who originally receives a diagnosis of type 2 diabetes may still get a separate diagnosis of type 1 at a later date. Type 2 diabetes is the most common type, so a doctor might initially suspect that an adult with diabetes has type 2.

What exactly does metformin do to your body? ›

Metformin works by helping to restore the body's response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.

Can you have LADA without antibodies? ›

Performing a GADA antibody test is the most common method of diagnosing LADA, but not all patients have these antibodies. In the very early stages of LADA, it is possible that there are no detectable antibodies, but they can develop over time.

Can you have LADA and be overweight? ›

Overweight/obesity is associated with increased risk of LADA, particularly when in combination with FHD. These findings support the hypothesis that, even in the presence of autoimmunity, factors linked to insulin resistance, such as excessive weight, could promote onset of diabetes.

Does Metformin help LADA? ›

Since LADA patients have some degree of insulin resistance, metformin is beneficial.

Is LADA better than type 1? ›

As a form of type 1 diabetes, LADA is the result of your immune system attacking the beta cells in your pancreas that produce insulin. The only difference is that this attack is slower which means your insulin production declines at a more slower rate compared to type 1—but a much faster rate compared to type 2.

Can autoimmune diabetes be cured? ›

Among them, type 1 diabetes, also named autoimmune diabetes, afflicts 10 million people worldwide. This disease is caused by autoimmunity-mediated destruction of pancreatic β-cells, leading to insulin deficiency, hyperglycemia and complications. Currently, there is no cure for type 1 diabetes.

Does LADA run in families? ›

Some reports suggest that LADA patients are unlikely to have family history of type 2 diabetes [10] while a recent study (Nord-Trøndelag Health Study) indicated strong evidence of family history as an important risk factor for LADA [11].

How long can you have type 1 diabetes without knowing it? ›

It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe. Some type 1 diabetes symptoms are similar to symptoms of other health conditions.

What can mimic diabetes symptoms? ›

  • Alcoholism.
  • Alzheimer's Disease.
  • Amenorrhea.
  • Amyloidosis.
  • Anorexia Nervosa.
  • Bulimia Nervosa.
  • Chronic Obstructive Pulmonary Disease.
  • Cirrhosis.

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