Latent autoimmune diabetes in adults: definition, prevalence, beta-cell function, and treatment.
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 beta-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 beta-cell function show that LADA patients with multiple islet antibodies develop beta-cell failure within 5 years, whereas those with only GAD antibodies (GADAs) or only islet cell antibodies (ICAs) mostly develop beta-cell failure after 5 years. Even though it may take up to 12 years until beta-cell failure occurs in some patients, impairments in the beta-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 beta-cell failure might be a more adequate concept. In agreement with proved impaired beta-cell function at diagnosis of diabetes, insulin is the treatment of choice.
Stenström
Gunnar
G
Department of Medicine, Kungsbacka Hospital, Göteborg, Sweden.
Gottsäter
Anders
A
Bakhtadze
Ekaterine
E
Berger
Bo
B
Sundkvist
Göran
G
D000328:Adult; D017668:Age of Onset; D015415:Biomarkers; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000276:immunology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000276:immunology; D018450:Disease Progression; D005947:Glucose / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000097:blood; D007515:Islets of Langerhans / Q000378:metabolism*; D011446:Prospective Studies; D013997:Time Factors
D015415:Biomarkers; D002096:C-Peptide; D007328:Insulin; D005947:Glucose