title: β-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up.
abstract: OBJECTIVE
  The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of β-cell function or metabolic control, compared with conventional treatment.
  
  
  METHODS
  Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged ≥ 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet ± oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary.
  
  
  RESULTS
  Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of ≥ 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet ± OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred.
  
  
  CONCLUSIONS
  Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted.
authors.affiliation: Department of Endocrinology and Diabetology, Lund University Hospital, Lund, Sweden. maria.thunander@ltkronoberg.se
authors.forename: Maria
authors.initials: M
authors.lastname: Thunander
authors.forename: Hlin
authors.initials: H
authors.lastname: Thorgeirsson
authors.forename: Carina
authors.initials: C
authors.lastname: Törn
authors.forename: Christer
authors.initials: C
authors.lastname: Petersson
authors.forename: Mona
authors.initials: M
authors.lastname: Landin-Olsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005934:Glucagon / Q000494:pharmacology; D006442:Glycated Hemoglobin; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use*; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D002096:C-Peptide; D005934:Glucagon; D006442:Glycated Hemoglobin; D007328:Insulin