title: Latent autoimmune diabetes of the adult: current knowledge and uncertainty.
abstract: Patients with adult-onset autoimmune diabetes have less Human Leucocyte Antigen (HLA)-associated genetic risk and fewer diabetes-associated autoantibodies compared with patients with childhood-onset Type 1 diabetes. Metabolic changes at diagnosis reflect a broad clinical phenotype ranging from diabetic ketoacidosis to mild non-insulin-requiring diabetes, also known as latent autoimmune diabetes of the adult (LADA). This latter phenotype is the most prevalent form of adult-onset autoimmune diabetes and probably the most prevalent form of autoimmune diabetes in general. Although LADA is associated with the same genetic and immunological features as childhood-onset Type 1 diabetes, it also shares some genetic features with Type 2 diabetes, which raises the question of genetic heterogeneity predisposing to this form of the disease. The potential value of screening patients with adult-onset diabetes for diabetes-associated autoantibodies to identify those with LADA is emphasized by their lack of clinically distinct features, their different natural history compared with Type 2 diabetes and their potential need for a dedicated management strategy. The fact that, in some studies, patients with LADA show worse glucose control than patients with Type 2 diabetes, highlights the need for further therapeutic studies. Challenges regarding classification, epidemiology, genetics, metabolism, immunology, clinical presentation and treatment of LADA were discussed at a 2014 workshop arranged by the Danish Diabetes Academy. The presentations and discussions are summarized in this review, which sets out the current ideas and controversies surrounding this form of diabetes.
authors.affiliation: Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.|Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.|The Danish Diabetes Academy, Odense, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Laugesen
authors.affiliation: Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.|Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.|The Danish Diabetes Academy, Odense, Denmark.
authors.forename: J A
authors.initials: JA
authors.lastname: Østergaard
authors.affiliation: Centre for Diabetes, The Blizard Institute, London, UK.
authors.forename: R D G
authors.initials: RD
authors.lastname: Leslie
mesh_terms: D000328:Adult; D017668:Age of Onset; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000503:physiopathology; D015551:Autoimmunity; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D003937:Diagnosis, Differential; D020022:Genetic Predisposition to Disease; D006801:Humans