Clinical review: Type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow.
BACKGROUND
The aim of this review was to explore the pathogenic and clinical spectrum of type 1 diabetes, which includes a form of adult onset autoimmune diabetes usually referred to as latent autoimmune diabetes in adults (LADA). We looked at this entire range of forms of autoimmune diabetes as a spectrum of genetic and nongenetic environmental influences, diabetes-associated immune responses, and metabolic changes.


METHODS
We assessed epidemiological, genetic, immunological, and clinical data from major articles on autoimmune diabetes, including LADA and type 1 diabetes, published since 1992.


RESULTS
Data analysis of autoimmune diabetes indi-cates that type 1 diabetes and LADA occupy different poles of the same spectrum.


CONCLUSIONS
Evidence is presented that LADA represents one end of a rainbow encompassing type 1 diabetes. The clinical nature and management of autoimmune diabetes poses important therapeutic questions regarding conventional therapy for hyperglycemia as well as therapy aiming to protect residual beta-cell function. Limiting loss of endogenous insulin secretion using immunomodulation could be valuable, not only for LADA but also for type 1 diabetes.
Institute of Cell and Molecular Science, Queen Mary College, University of London, London E1 4NS, United Kingdom. r.d.g.leslie@qmul.ac.uk
R David G
RD
Leslie
Rhys
R
Williams
Paolo
P
Pozzilli
D001327:Autoimmune Diseases / Q000235:genetics* / Q000276:immunology / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000235:genetics* / Q000276:immunology / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D006801:Humans