title: Latent autoimmune diabetes in adults is perched between type 1 and type 2: evidence from adults in one region of Spain.
abstract: BACKGROUND
  The aim of this study was to characterize the clinical characteristics and insulin secretion in adults with latent autoimmune diabetes in adults (LADA). We also compared these characteristics in subjects with antibody-negative type 2 diabetes (T2DM) or adult-onset type 1 diabetes (T1DM) to subjects with LADA.
  
  
  METHODS
  In this cross-sectional study, 82 patients with LADA, 78 with T1DM and 485 with T2DM were studied. Clinical and metabolic data, in particular those that related to metabolic syndrome, fasting C-peptide and islet-cell autoantibodies [glutamic acid decarboxylase (GADAb) and IA2 (IA2Ab)] were measured.
  
  
  RESULTS
  The frequency of metabolic syndrome in patients with LADA (37.3%) was higher than in those with T1DM (15.5%; p = 0.005) and lower than in patients with T2DM (67.2%; p < 0.001). During the first 36 months of the disease, the C-peptide concentration in LADA patients was higher than in subjects with T1DM but was lower than in T2DM patients (p < 0.01 for comparisons). Glycemic control in LADA patients (HbA1c 8.1%) was worse than in patients with T2DM (HbA1c 7.6%; p =0.007). An inverse association between GADAb titers and C-peptide concentrations was found in subjects with LADA (p < 0.001). Finally, LADA patients rapidly progressed to insulin treatment.
  
  
  CONCLUSIONS
  As in other European populations, patients with LADA in Spain have a distinct metabolic profile compared with patients with T1DM or T2DM. LADA is also associated with higher impairment of beta-cell function and has worse glycemic control than in T2DM. Beta cell function is related to GADAb titers in patients with LADA.
authors.affiliation: Centre d'Atenció Primària de Cervera, Institut Català de la Salut, Lleida, Spain.
authors.forename: Angels
authors.initials: A
authors.lastname: Mollo
authors.forename: Marta
authors.initials: M
authors.lastname: Hernandez
authors.forename: Josep R
authors.initials: JR
authors.lastname: Marsal
authors.forename: Aureli
authors.initials: A
authors.lastname: Esquerda
authors.forename: Ferran
authors.initials: F
authors.lastname: Rius
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanco-Vaca
authors.forename: Joan
authors.initials: J
authors.lastname: Verdaguer
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
authors.forename: Alberto
authors.initials: A
authors.lastname: de Leiva
authors.forename: Didac
authors.initials: D
authors.lastname: Mauricio
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity; D002096:C-Peptide / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000276:immunology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000276:immunology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology
chemical_list: D001323:Autoantibodies; D002096:C-Peptide; D007328:Insulin
keywords: C-peptide; glutamic acid decarboxylase antibodies; latent autoimmune diabetes in adults; metabolic syndrome; type 1 diabetes mellitus; type 2 diabetes mellitus